A few years ago, a provider called me for help. He was being audited and the payer had told him that he owed 100K in overpaid claims. We did a review and immediately saw the problem. He did, in fact, owe the money to the insurance company.
It was an honest mistake and something a trained auditor would have picked up on right away. However, he didn’t have a trained auditor conducting his audits, instead, he had a coder doing it. And, until he called me, he’d never hired an outside opinion.
I see this all the time. Compliance is expensive and a lot of providers don’t want to invest in their compliance program. Often, they don’t see the value until it’s too late and they owe a fortune. There’s a growing trend of providers outsourcing their audits as a more cost-effective way to maintain compliance.
When implementing your compliance audit plan, you’ll probably get to a point where you’ll ask yourself whether or not you should outsource coding and documentation audits. Outsourcing can benefit every organization by improving the quality of your audit and supplementing your compliance program among a number of other things.
But, before you choose to outsource, it’s important to learn how to evaluate an external audit company to ensure that you reap all of the benefits.
Evaluate A Third-Party Vendor Based On The Following:
- Skill set and resources
- Reporting and flexible scoring methodologies
- Post-audit education
- Industry knowledge
Auditors should be credentialed professionals with at least 3 years experience auditing. And, it’s important that you verify their credentials before hiring.
Watch our on-demand webinar, "How To Properly Vet A 3rd Party Auditor," to learn how outsourcing can help you save time, improve internal operations, and provide validation to your coders and physicians.