Healthcare Revenue Cycle Audits: A Practical Guide

What Are Revenue Cycle Audits?

Recent studies report that 86% of claim denials are avoidable. Are you seeing a high number of claim denials or billing and coding errors? If so, it may be time for a healthcare revenue cycle audit.

Revenue cycle audits are a systematic review of processes that manage the financial aspect of healthcare services. These audits are crucial for identifying inefficiencies, ensuring compliance, and improving billing accuracy.

To enhance your understanding of how to optimize your revenue cycle, explore our Revenue Cycle Management solutions.

Types of Revenue Cycle Audits

What is an Internal Audit?

Internal audits are conducted by staff within the organization to identify potential issues and improve processes. These audits provide a proactive way to address inefficiencies before they grow into larger problems.

Benefits of Internal Audits:

• Address issues early
• Leverage internal expertise
• Save on costs compared to external audits

What is an External Audit?

External audits involve a third-party reviewer who can provide a fresh, unbiased perspective. These audits are particularly useful when preparing for regulatory reviews or ensuring compliance with industry standards.

Benefits of External Audits:

• Objective assessment
• In-depth analysis of processes
• Greater preparation for regulatory inspections

When to Use Each?

Internal audits are ideal for routine checkups, while external audits are better suited for comprehensive reviews or when preparing for external regulations. Both approaches work together to ensure optimal operations.

For a deeper dive into how audits can uncover inefficiencies and improve financial performance, check out our Revenue Analysis solutions.

Why Conduct a Revenue Cycle Audit?

Key Objectives

Revenue cycle audits are essential for improving efficiency, ensuring compliance, and maintaining financial stability.

• Identifying inefficiencies in processes
• Ensuring compliance with HIPAA regulations and contracts
• Detecting redundancies and common coding and billing errors
• Determining if further education and training for staff are needed

Key Benefits

Revenue cycle audits offer numerous benefits, including:

• Improved financial performance
• Reducing claim denials
• Enhanced staff efficiency and communication
• Discovery and reduction of fraud and improper payments
• Streamlined operations

5 Steps to Preparing for a Revenue Cycle Audit

Step 1: Define the Scope

Determine whether the audit will be comprehensive or focused on specific areas. Define the number of records you’ll review and the time period for the investigation.

Step 2: Assemble the Audit Team

Choose qualified professionals with expertise in billing, coding, and compliance. This could include health information managers or external consultants.

Step 3: Set Clear Goals

Clearly outline what the audit should achieve, whether it’s reducing claim denials, improving compliance, or identifying training needs.

Step 4: Conduct the Review

Systematically analyze your processes and records to identify gaps or inefficiencies.

Step 5: Take Action on Findings

Based on the audit findings, implement corrective measures which could include training staff, hiring additional personnel, or streamlining processes.

Common Challenges in Revenue Cycle Auditing

Challenges

• Identifying all areas of inefficiency
• Ensuring compliance with regulatory standards
• Overcoming staff resistance to changes

Solutions

• Provide regular training to keep staff up to date
• Invest in technology to improve accuracy and efficiency
• Partner with experienced auditors for expert insights

At TruBridge, we help healthcare organizations streamline their revenue cycle processes. Our team works closely with you to analyze billing, coding, and electronic health record (EHR) management policies.

Why Choose TruBridge?

• Deep expertise in revenue cycle management
• Tailored strategies to reduce claim denials and inefficiencies
• Support for both internal and external audits