The Value of Internal Audits in your Revenue Cycle Program

An internal audit program is a required component of your Compliance Plan, but if done right it can also help you to maximize your RCM collections.

It is not enough to have good billing policies in place. You must also confirm that they are being followed. A strong RCM internal audit program reviews all aspects of the billing and collections work, including but not limited to ensuring that:

• Charges are being entered accurately with diagnosis, dates of service, CPT code and modifier.
• Payments are posting to correct claim, correct adjustments are made, and that balances are properly billed to the secondary payor or patient.

• Outstanding claims are worked timely, proper notes are being kept and the claims are rebilled as appropriate.

Regular and ongoing audits will not only uncover areas requiring quality improvement but will also identify training opportunities for your staff. When reviewing your audit findings, ask yourself the following questions:

Is everyone following best and consistent practices, and are workflows streamlined? Appropriate workflows and processes can reduce your days in accounts receivable and increase your overall collections.

Are you taking advantage of all features in the billing system to improve your processes? Consistent, proper billing practices will result in maximum collections.

Beyond maintaining consistent adherence to policies, is your team is working as smart and efficiently as possible? Highly trained and confident staff equates to better work and higher productivity, and even a small increase in staff productivity will result in higher and more timely collections.

A strong internal audit program will help you stay compliant and, if executed correctly, can play a major role in optimizing your collections and bottom line.

If you have further questions about internal audits or RCM, we’re here to help. Contact us today to set up a conversation.

Carolyn Schuemann, VP Finance, Administration & Compliance & Michelle Davis, Process Improvement Specialist