Healthcare Compliance Can Deliver an ROI

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Compliance budgets have remained relatively stagnant over the last ten years. In many cases, compliance departments are viewed as nothing but a cost center. It is amazing if you google “compliance department,” how often the words “necessary evil” come up in the search results. That negativity comes from compliance being rooted in laws, constraints, inspections, audits and penalties for those who don’t follow the rules-knowingly or unknowingly.

While health care organizations are absolutely aware of the necessity of compliance programs to prevent unethical conduct and violations of the law, it is viewed as an administrative annoyance that wastes valuable time, effort and resources from workers who would much rather be doing things that are innovative, inspired, and motivating. Compliance is what you HAVE to do, rather than what anyone WANTS to do.

If you look at health care news, the cost of non-compliance is very real. Fraudulent billing and intentional, consistent upcoding have resulted in millions of dollars in fines and penalties for many health care providers. But there is another problem that organizations also face and that is under billing for services, so that they are literally leaving money on the table.

There are a couple of reasons that underbilling occurs. It can be the result of failure to update your charge master, coding errors or unfamiliarity with coding guidelines. Appropriate evaluation and management (E&M) code billing patterns are well established, based on years and years of historical data. Having visibility into your organization’s own coding patterns is a need for many to evaluate both the compliance of their program but also to determine if underbilling is occurring. Enter coding analytics, a solution that evaluates the totality of your E&M services to identify both under and over coding situations.

This solution allows the organization to compare their billing patterns against national benchmarks to determine if they are appropriate or not. It is a proactive approach to billing compliance, but it also has the silver lining of potentially providing a return on investment in two ways: 1)identification of underbilled services that should be adjusted and 2)the ability to prove to an auditor that there is already a robust and routine monitoring system in place and that the organization strives to bill correctly in all instances to prevent any penalties or fines.

Coding analytics is a solution that enables organizations to take command of their data to achieve peak business health.

Interested in learning more? The team at VisiQuate is focusing on how we can help hospitals optimize their revenue cycle management. Visit our Revenue Cycle Playbook for step-by-step plays to help you stay on top of the ever-changing landscape of healthcare revenue cycle, or contact us to schedule a demo.

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