Within the healthcare system, organizations do their very best to make sure every provider that comes onboard is accredited and qualified. But once they’re part of a practice, how do we make sure the organization is functioning at its highest potential? In an ever-changing system, the importance of bettering the quality of healthcare we carry out is imperative. One of the ways to do this is through internal audits. By making sure an organization is functioning as intended, we are able to identify the areas that are thriving and oftentimes, the areas that need improvement.
What Is an Internal Audit?
An internal audit is when a third party expert thoroughly examines your organization in an effort to add value and improve daily operations. These audits should be performed annually, and every task your organization carries out in relation to your management systems will be analyzed under a microscope. In doing this, you’re able to ensure even your most well-trained employees are up to par. Oftentimes, when we execute the same tasks daily, it can be easy to develop bad habits that, in turn, affect revenue.
Internal audits should always be performed by a trained third party professional. This allows them to step in with a fresh set of eyes to better pinpoint potential issues. Most auditors in the healthcare industry have vast experience in revenue cycles, medical coding, and hospitals’ daily routines. When your audit report is complete, you should be left with a list of actionable steps to help improve your organization. By making these suggested changes, you should see growth in your revenue cycle and patient/employee satisfaction ratings.
Overall Goal: Improve Revenue
It goes without saying increasing revenue is (and should be) a top priority for any institution. There are many small factors that go into the monstrous task of growing revenue. When an internal audit is conducted, the end goal is to point out every possible factor that is currently hindering the growth of an organization.
Most often, the errors an auditor will point out will fall under one of the below buckets:
- Reveal incorrect billing practices
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- When seeing a high volume of patients, it’s easy for a billing department to take shortcuts. However, these shortcuts can come with costly consequences, such as duplicate charges and incorrect patient information, which can result in fines.
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- Identify any coding errors and/or errors in physician documentation
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- If a provider mistakenly inputs the wrong notes and/or codes into a patient's document, this can cause substantial delays in receiving payment, as claims will be denied.
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- Provide a better quality of care to patients
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- As a patient, most of us would agree that we would not return to a poorly run organization if we had a bad experience (if we have the choice). By improving billing errors, waiting times, and overall patient care, you create a safe space for patients who want to return.
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In short, increasing staff accountability in all the above areas will help minimize costly mistakes. When staff is aware of the mistakes they’re making, they are able to better their process to reduce overall costs to an organization.
Importance of KPIs in an Audit
Key Performance Indicators (KPIs) are crucial quantifiable markers that measure growth toward a specific goal. When an organization outlines their KPIs, it holds them accountable by providing standards for improvement. These KPIs are meant to increase provider and patient satisfaction and improve revenue. Without measurable KPIs, how do we achieve goals as an organization?
When a third-party auditor comes in to conduct an annual audit, they should evaluate your KPIs and see where you’re measuring up to the outlined goals. The KPIs they will focus on are often related to growth, productivity, financial performance, and people. In examining these KPIs, an audit will help improve patient care by bringing transparency and accountability into an organization's management system.
How Inlera Can Help
By investing in an annual healthcare audit, not only are you taking the necessary steps to better your organization, you are also setting a strong foundation for all staff to ensure they follow procedures that are set in place for a reason. In addition, when internal audits are completed, you don’t have to sweat any external audits that may be coming up, as you’ve already taken the necessary steps to improve your process.
At Inlera, we are committed to adding value to your practice by boosting your bottom line. We will take the monotonous workload of medical billing, insurance credentialing, and more off your already full plate so you can focus on treating patients. Contact us today to learn how we can help serve you.
Jasmine Vializ is the President and CEO of Inlera, a billing and practice management company designed to increase the quality of healthcare by helping doctors to prioritize their patients while boosting their bottom line.
