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Decoding the alphabet soup of future audit risks.

Lori Brocato¹, Lynne Byrd, Dawn Crump

¹HealthPort, Alpharetta, GA, USA. lori.brocato@healthport.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association

|June 23, 2011

Summary

Healthcare organizations face increasing audit threats in 2011, particularly from Zone Program Integrity Contractor audits. A proactive strategy, including clinical documentation improvement and physician education, is crucial for mitigating revenue loss from these extensive reviews.

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Area of Science:

Healthcare management
Medical auditing
Revenue cycle management

Background:

Healthcare organizations are anticipating a significant increase in audit threats in 2011.
Zone Program Integrity Contractor (ZPIC) audits pose a substantial risk due to their potential to review up to 10 years of records.

Purpose of the Study:

To advise healthcare providers on proactive strategies to manage and mitigate audit risks.
To highlight key components of an effective audit defense strategy.

Main Methods:

Implementing a robust clinical documentation improvement (CDI) program.
Prioritizing comprehensive physician education on documentation best practices.

Main Results:

Proactive measures are essential for navigating all types of audit situations effectively.
Clinical documentation improvement and physician education are identified as critical for reducing potential revenue losses.

Conclusions:

Healthcare organizations must adopt a proactive stance to address escalating audit threats.
Investing in clinical documentation improvement and physician education is vital for financial health and compliance.