In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan delves into the complex and pressing topics of audits, compliance, and documentation. Joined by expert Brenda Edwards, who has extensive experience in healthcare revenue cycle, they discuss the rising frequency and importance of audits, sharing insights and real-world examples, including metadata and audit trails. Brenda emphasizes the need for thorough documentation to support services billed and advises on how to handle audit letters without panic. Practical advice is given to ensure that organizations remain compliant and prepared for inevitable audits. The episode also highlights the need for internal and external audits, the importance of having a compliance plan, and the potential benefits of integrating thoughtful automation into the audit process.
00:38 Meet Brenda Edwards: Background and Expertise 00:52 Understanding Audits: Who, Why, and How 00:58 Real-World Example: Incident Two and Split Shared Services 01:16 Practical Takeaways: Responding to Audits 01:26 Disclaimer and Scope of Discussion 01:59 Starting the Conversation with Brenda 02:09 The Growing Importance of Audits 03:03 Brenda's Journey in Auditing 09:54 Compliance and Documentation: Best Practices 10:58 Cardiology Audit Case Study 11:44 The Role of Metadata in Audits 16:18 The Consequences of Improper Access 26:02 The Long-Term Impact of Audits 26:52 First Offense Penalties and Compliance Plans 28:43 Case Study: EHR Upgrade Issues 30:09 Legal Implications and Repeat Offenders 31:57 Handling Sanctioned Providers 34:04 Responding to Audit Notifications 34:33 Educational vs. Recoupment Letters 42:07 The Importance of Documentation 46:39 Final Thoughts and Takeaways
