AUDIT ANALYSIS ON RCM OPERATIONS
Regular Audits on end-to-end RCM operations are essential to discover your Practice financial health. A credible source is needed to perform a comprehensive audit focusing on factors influencing the practice revenue.
Our highly skilled team performs an intense audit starting from credentialing to collection works engaged in the RCM process.
If your practice has EMR integrated with PMS systems, our audit works will focus on clinical data sampling also to ensure there is documentation compliance, progress notes are signed timely and ensure there is quality in operations in all pre-billing areas that are inter-related to the progress notes and encounters within EMR module.
At Life Line Billing Solutions, we do apply a Six Sigma concept DMAIC (Define, Measure, Analyse, Improvement & Control) for a high-quality audit focusing on resolving the identified process gaps & setting a crystal-clear workflow in RCM operations.
Outline the scope of audit, create a VSM (Value Stream Map); audit targeting areas shall be clinical side, administrative, front office, coding, billing, clearing house, payment posting, patient billing , collection agency coordination works and the technology in use in all the RCM operations.
We do measure the sample data using the KPIs (Key Performance Indicators) defined by HFMA (Healthcare Financial Management Association) & MGMA (Medical Group Management Association).
At this phase, our goal is to identify and test
the underlying causes of the process gaps to make sure that, improvement takes place from deep down where the problems stem from.
- We do perform a complete root cause analysis (RCA)
- Do a FMEA (Failure Mode & Effects Analysis) to identify all possible problem areas, inefficiencies, flaws, defects, and shortcomings.
After this phase, we will be able to capture and document all opportunities for improvement successfully, and the plan of action will start taking shape.
Having all the possible factors influencing the process gaps, we do a provide feedback that is extremely important to focus on the improving the workflow. A check list of all conflicts identified with the RCM workflow will be shared to clients.
We suggest for revising SOP (Standard Operating Procedure) document in each of the work area of issue – from the findings and recommendations found from the preceding stages.