Worried About Getting Audited?

Turn to Technology to Reduce Your Compliance Risks and Increase Employee Satisfaction

As a healthcare payer, you work hard to process claims, manage appeals and grievances, and satisfy your members. But, despite your best compliance efforts, the risk of an audit and its potential consequences are always looming.

If your employees complete tasks manually, you’re increasing those risks by inviting the opportunity for human error. Research shows an average person makes three to six errors per hour, regardless of what type of work they’re performing. And when an employee works a longer than regular shift, that error rate jumps by 9%.

To reduce your organization’s compliance risks, start with a review of your existing processes and technologies. The answers may be closer than you think.

Time + Pressure: Audit deadlines show the gaps

When you learn of an audit, it’s all hands on deck. The need to meet very tight deadlines often reveals a few areas for improvement.

If, like most payers, you don’t have dedicated staff to handle audits, you’ve got to quickly reorganize workers to locate and assemble the requested information. Shifting existing staff to “other duties as assigned” means their regular workloads fall by the wayside. And after what may have been a stressful audit experience, your staff may feel overwhelmed by just the thought of having to catch up. This is especially true if they had to scramble to find the requested data.

When there isn’t a “single source of truth” from which to pull the required information, it’s on your staff to hunt it down before they can even begin to place it into the requested format. With the penalties for not being able to find the information, or not being able to produce it in time, costing your organization thousands or even millions of dollars, there’s a lot of pressure on your staff.

Technology levels up your compliance and employee satisfaction

Whether you’ve had a recent audit or haven’t had one in years, it’s in your best interest to be better prepared. Technology is a valuable tool that delivers significant advantages over manual processing.

For example, if your staff manually complete tasks and rely on data located between various spreadsheets and databases to do so, processes take too much time and responding to an audit is very difficult. With the right technology, you’ll see improvements in day-to-day operations as well as in your audit preparedness, including:

  • Eliminating errors. Technology eliminates the human errors associated with manual tracking. Of course, you still need to take action to stay in compliance, but a good tool has compliance rules built into the product to help you avoid falling out of compliance.
  • Creating a single source of truth. Responding to an audit is more difficult when data is scattered across departments. In addition, manually gathering the required data introduces human error and risk. Relying on technology to provide single source of truth mitigates this risk.
  • Reducing time spent re-formatting data. While your organization may call a certain data value one thing internally, the regulator likely calls it something different. Correcting this discrepancy is time consuming as you need to not only pull the right data, but also ensure it’s in the right format. Technology can do this for you, so you don’t waste valuable employee time.
  • Creating more accurate reports faster. Technology solutions that help you stay in compliance also creates reports much faster than compiling them by hand. Instead of an employee spending weeks manually pulling data from different sources, they can enter a date range, click a button and quickly pull a report to prove compliance.

Additionally, technology ensures compliance as your staff completes their day-to-day tasks. With compliance rules built into the application, staff receive alerts when an action needs to happen to avoid missing a compliance deadline.

Improving productivity and minimizing risks

Employees need resources to handle the occasional audit assignment as well as the increased workloads that await them afterwards. To manage volume, typically health plans hire more people, either FTEs or temp workers, or pay overtime. But, what if instead of throwing more people at the problem, health plans looked to technology?

If it takes an employee 10 steps to complete a task and technology can reduce those steps to four, that significant time savings allows your organization to process more volume in less time. It also means your employees have an easier time completing their work and feel more productive.

If you worry about how you would respond to a potential audit, or how hard it was to have responded to one already, technology can help. By being proactive and employing tools that eliminate risks and expedite processing, allows staff to handle audits quickly and efficiently, with fewer demands and less risk of incurring expensive violations.