In healthcare, funder audits are inevitable at one point or another. Most ABA organizations have or will one day go through an audit. Staying audit-ready with a comprehensive compliance plan is your best defense against audits–but what happens when an audit uncovers areas of non-compliance?
While it may temporarily feel like a setback, audit findings can serve as a valuable opportunity to refine processes, strengthen compliance, and improve your operations. This blog will guide you through the vital steps to take after an audit to ensure your practice resolves compliance issues and establishes a stronger culture of compliance moving forward.
Analyze Audit Findings
After a payor finalizes an audit, the first step is thoroughly analyzing the results.
- Engage a compliance team. Develop a compliance team to review the findings and identify specific areas of non-compliance. Key team members from each relevant department (e.g., billing, clinical, finance) should be part of the audit review team. This will help to comprehensively pinpoint areas of necessary improvement in each target area.
- Review and categorize compliance issues. Identify and review the specific areas of non-compliance noted in the payor’s audit report. It’s helpful to separate them into distinct categories, such as documentation errors and billing discrepancies.
- Rank compliance issues by severity. To adequately allocate your team’s time and resources, rank each compliance issue based on its severity and urgency. When ranking, consider both the financial impact of the compliance issues and the long-term repercussions, such as loss of payor contracts.
Develop a Post-Audit Improvement Plan
After an audit is completed, it’s crucial to take the necessary steps to address any identified issues and prevent future disparities. A Post-Audit Improvement Plan is essential for transforming audit findings into actionable changes that bolster compliance. The following outlines three key steps to help guide your planning.
- Define Clear Goals
Develop clear goals based on the audit findings. Consider what needs to change or improve to avoid non-compliance with payor regulations.
Depending on the specific challenges highlighted in your audit report, some potential goals your practice might set include:
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- Improve compliance with documentation standards. See how to audit 100% of session notes and ensure every session note is payer-compliant.
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- Prevent claims denials. Learn how to audit 100% of claims and improve claim cleanliness.
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- Avoid future audits. Use our checklist to maintain compliance year-round.
- Avoid future audits. Use our checklist to maintain compliance year-round.
- Assign Responsibility
Begin preparing for the implementation of post-audit solutions by assigning compliance team members to oversee each solution. Clearly define the roles and responsibilities of each individual and team.
Some of your audit teams may include:- Documentation team
- Billing team
- Technology team
- Training team
- Allocate Resources
Bolstering compliance with a comprehensive post-audit improvement plan is a long-term investment. Ensure you have the necessary resources to support the improvement plan, including the budget for administrative and training time, tools, and technology.
Implement Post Audit Improvement Solutions
The next step includes putting it all into action. Develop and launch concrete solutions that address not only the symptoms of audit failures but also the root causes. The post-audit solutions you implement may include a combination of the following, among others.
- New or updated policies and procedures
- Improved documentation standards
- Internal claims and session note auditing
- Refined workflows
- Strengthened billing and compliance training
- Utilizing software and other tools to streamline operations
Monitor Key Performance Indicators
Measuring the progress of your compliance improvement plan is essential to ensure your improvements are effective. Utilize Key Performance Indicators (KPIs) as a clear and objective way to monitor your compliance standards and identify if further changes are needed.
Track the following KPIs to monitor compliance:
- Internal pre-billing audit score
- Internal documentation audit score
- Clean claims rate
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