Author Topic: Hospital Auditing... Auditing in General  (Read 4091 times)

QueenAlicia

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Hospital Auditing... Auditing in General
« on: August 06, 2012, 04:17:14 PM »
In regards to auditing can anyone share information on what the process is. 

How do you complete a chargemaster review? 

Michele

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Re: Hospital Auditing... Auditing in General
« Reply #1 on: August 07, 2012, 05:08:29 PM »
Not sure what you mean by "Chargemaster review".  Do you mean the fees that the provider is charging.  For me I don't have one process I follow for auditing.  It depends on the situation, what the problems are, and what I'm (the provider) is looking for.  It also depends on a lot of things like what PM system they use?  Do they do the billing in house?  How much time do I have in the office?  Am I doing a full audit, or just one particular insurance carrier?  Who is doing the billing?  Lots of variables.  Sorry, I don't feel like I helped much.  :(
« Last Edit: August 07, 2012, 05:10:15 PM by Michele »
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QueenAlicia

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Re: Hospital Auditing... Auditing in General
« Reply #2 on: August 07, 2012, 05:14:45 PM »
It was for a hospital and I assume that they wanted a review of all the lab claims to review.  They also wanted an inhouse interview of their staff on their billing procedures.

It was a lot of unanswered issues in the proposal.  They weren't to clear as to what they exactly wanted.

Michele

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Re: Hospital Auditing... Auditing in General
« Reply #3 on: August 07, 2012, 05:24:59 PM »
I would make sure they are specific in what they want.  You can't do a good job if you don't know what they are looking for.  The inhouse interview shouldn't be a problem but you need to know what they expect you to accomplish.
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QueenAlicia

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Re: Hospital Auditing... Auditing in General
« Reply #4 on: August 08, 2012, 04:43:10 PM »
Yes, I turned it down because I do not know all of the qualifications and don't want to bid and take a job that could possibly ruin my business reputation.

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Re: Hospital Auditing... Auditing in General
« Reply #4 on: August 08, 2012, 04:43:10 PM »

Michele

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Re: Hospital Auditing... Auditing in General
« Reply #5 on: August 08, 2012, 05:06:26 PM »
Sometimes that is the best thing to do.  I hate to turn down anything.  Once my Pastor said "it would be like trying to empty the ocean with a spoon" and I found myself thinking "well, if you had a good size spoon and you started early....."   You gotta know when to say "no".
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DMK

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Re: Hospital Auditing... Auditing in General
« Reply #6 on: August 08, 2012, 06:59:48 PM »
And that, Michele, is why you're a good business person!  You were looking for HOW you could empty the ocean more efficiently, and you were willing to do the work!

Michele

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Re: Hospital Auditing... Auditing in General
« Reply #7 on: August 13, 2012, 11:15:13 AM »
Well they say that your best asset is your worst asset turned around.  :)
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PMRNC

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Re: Hospital Auditing... Auditing in General
« Reply #8 on: August 14, 2012, 12:56:34 PM »
Before I do any proposal on this type of work I ask a lot of questions, the first one being :  "What is the goal of the review/audit"  This is important because we all know that good data in is good data out.  I have been contracted to do audit's for such things for example, like, reviewing a certain carrier to be sure they were not losing money with contracted write-off's.  BUT.. if that practice was not specifically naming their adjustments that's bad data in, and they were going to come out of this with bad data out.  In those situations I recommend training the staff on proper payment/adjustment procedures.  When data is entered properly you can extract almost ANY report you want for any reason!  I've also done work where a practice wants to review their own patient write-off's to which I do an audit to show them where they are losing money.   If you ask the main question of what they intend to achieve with what they want done, you'll find you can sit down and pretty much find a way to get them the info they need.. ASSUMING the data is clean.  I also review their database before i do anything!
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Re: Hospital Auditing... Auditing in General
« Reply #8 on: August 14, 2012, 12:56:34 PM »