Revenue cycle leaders at the University of Utah Health successfully established an automated and streamlined audit process that identifies potential errors at the point of coding.
It's no secret that a streamlined auditing process can optimize an organization's revenue cycle and increase reimbursement. And while implementing an automated auditing process can benefit most departments within the revenue cycle, a great place to start is within the middle revenue cycle: coding.
HealthLeaders spoke with Gail Draper, revenue integrity director at the University of Utah Health (U of U Health), to share the organization's experience on implementing an automated audit process.
Draper says that "quality is always top of mind. Our teams are always looking for better ways to be efficient and bring stronger value to our organization."
Helping to oversee the execution of the new auditing software within the coding department was Nancy Treacy, MPH, RHIA, CDIP, CCS, who works in data integrity at U of U Health.
"Implementing new processes within the revenue cycle takes time and work. But taking the leap from a manual, disparate process to an automated and streamlined one is worth the growing pains," says Treacy.
Since implementation, Draper says that multiple owners in the audit process now utilize a single platform to record, communicate, educate, and manage outcomes with one consistent tool at their organization.
U of U Health has also seen a number of tangible benefits, including a monthly production increase of retrospective audits that went from 5% to 10%.
"The ability to drive postbill and prebill audits heightens our capacity to change," says Draper. "It also improves coding compliance, creates timely feedback through training and education, and enhances reporting to measure against our revenue integrity goals."
U of U Health has a dedicated commitment to quality, which is why it works across its revenue cycle with an integrated auditing and coding team made up of nurses, coders, auditors, educators, and quality liaisons.
The team works closely together, sharing information and communicating openly, says Treacy.
"Like many other health systems, our audit process started in a spreadsheet-based world. Each auditor had their own spreadsheet, their own process, and focused on different audit elements. It was not a unified approach and led to sharing dissimilar feedback in different formats for our coders," says Treacy.
The organization went through several iterations to streamline this process, but from unifying spreadsheets and conventions to trying to automate portions by hand, everything was still too manual.
It was taking too long to find trends and stats within the data available, says Treacy.
This is when revenue cycle leaders stepped in, as they were approached to test out new auditing software.
U of U Health's coding and clinical documentation integrity departments were already using the 3M™ 360 Encompass™ system, so when asked about being a beta site for the 3M 360 Encompass Audit Expert System | Code Audit software, they jumped at the opportunity.
The organization's goal was to ultimately become more efficient. Through its work as a beta site, U of U Health was able to establish a process that would identify potential errors at the point of coding and manage all coding and review activity within a single platform.
Transitioning to the prebill review process was also important to the organization to eliminate rebills, enabling coders and auditors to work together and provide timelier, more complete feedback. This, integrated with their retrospective audit process, helped streamline the prospective and retrospective process.
According to Treacy, the organization is now able to:
- Conduct the prebill auditing process in a quicker timeframe, resulting in billing the account just one time
- Increase prebill audit numbers from a handful of audits each month to an even split between retrospective audits and prebill audits
Because of the success of having an automated audit process, Treacy outlined three keys to success that she says helped U of U Health, and in turn, can help other organizations hoping to streamline their audit processes.
Key 1: Find a champion
Like any other big change, finding someone who believes in it, can build the business case, and shepherd the change from start to finish is a critical part in finding long-lasting success.
Champions need to be people who see the opportunity and can rally necessary stakeholders around the cause. They can encourage others to get involved and feel invested, and they should be the first ones to bring the team back to the vision when needed.
Key 2: Communicate early and often
Start conversations about changes long before change happens. U of U Health had an ongoing dialogue with team leaders early on, before implementation, to keep them informed, get their feedback, and manage their expectations. The champion should also work to build a strong, open rapport with stakeholders before challenges arise.
Key 3: Build smart, not fast
While time is always of the essence in the revenue cycle, implementing wider-scale change, like new processes and software, is better taken at a methodical pace.
U of U Health was careful not to do too much too soon and wanted to be sure the workflow was right before getting too far into the process, says Treacy. And at least once in the process, it held off on implementing the next stage until issues were resolved and teams were truly ready to move on.
A timeline should be realistic and have a level of flexibility to it.
As revenue cycle leaders toy with the idea of looping in directors and managers on ways to improve their audit processes, it's important to remember that audits have benefits outside of the organization as well.
The ultimate reason for automating and streamlining an audit process goes far beyond making the jobs of those in the middle revenue cycle easier, says Treacy.
"I believe coders and auditors are patient advocates. Patients are tasked with so much responsibility beyond focusing on getting well, and we help make sure they have a quality experience all the way to the end. With the proper tools and processes, we can ensure they get sent only one claim, helping to reduce confusion about what they can expect to pay. That's something we take seriously and are proud of," says Treacy.
“Quality is always top of mind. Our teams are always looking for better ways to be efficient and bring stronger value to our organization.”
Gail Draper, revenue integrity director at the University of Utah Health
Amanda Norris is the Revenue Cycle Editor for HealthLeaders.
- Moving to an automated auditing process can create a more consistent, proactive, and accurate workflow.
- When implementing a new software, find a champion to build a strong, open rapport before challenges arise.
- Big changes take time: the implementation timeline should be realistic and have a level of flexibility to it.