Clinical Chart audit still an important tool for improving healthcare.
For all healthcare organizations, an integral component of their compliance program is audit. In the current regulatory environment, healthcare providers are under greater scrutiny than ever before.
Claim rejections, claim denials and third-party defense audits create considerable financial burden for US hospitals and health systems. In order to avoid losses associated with denied inpatient claims or third-party defense audits hospitals and health systems need to pivot from denial management to denial prevention, by establishing monthly concurrent chart audit and inpatient chart review as an effective reimbursement retention strategy.
One of the common objections to establishing a monthly concurrent audit is increased initial cost. However, even when hiring one or two additional full-time staff members or enlisting consultant resources, the savings in terms of compliance and revenue opportunities typically outweigh the cost of these individuals or services.
Every revenue generating department within the hospital must properly document and record charges in order to establish control mechanisms to ensure that appropriate procedures and charging protocol are being followed.
The purpose of Concurrent Audit is verifying that charges on the detailed itemized hospital bill are accurate and that charges represent services rendered to the patient and are ordered by physician and are based upon standard hospital practices and/or nursing protocols and procedures.
A professionally trained Medical Chart Auditor with a strong clinical and billing experience assisting the appropriate department managers and nursing departments with maintaining and/or developing Charging Protocols and Policies in all revenue producing departments can play a significant role in identifying, correcting, and improving the charge practices within each department.
A complete Concurrent Chart Audit should include not only precise audit details providing audit outcomes but also a detailed monthly audit statistic report to identify departments showing a trend of over charges and under charges including departmental error rates. These audit statistic reports, help to identify the reasons why the over and under charges are occurring and can further assist departments in creating a corrective action plan for resolution to prevent errors from reoccurring.