Responding to Pre-payment Audits

HIM leaders will need to dig into pre-payment audit activity at their organization.

A version of this article was first published January 11, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: We're seeing a significant increase in pre-payment audit activity. How can we adapt our audit and denial management processes to cope with this shift?

A: Creating a unified, lean, and effective pre-payment audit response is a key part of an organization’s success, according to Dawn Crump, MA, SSBB, CHC, senior director of revenue cycle solutions with MRO in Norristown, Pennsylvania.

HIM leaders will need to dig into pre-payment audit activity at their organization, collaborate with key stakeholders across departments, and manage practical interdepartmental processes. Like any new undertaking, break it down into smaller goals and take it step by step.

Keep these three tips in mind when developing your organization’s pre-payment audit strategy:

1. Don’t try to be everywhere at once. Focus on the areas that will see the greatest return on investment rather than trying to drill down into every claim and payer, Crump says. Pay attention to high-dollar claims and analyze your data to learn which of your biggest payers submit the most pre-payment audits or payment integrity requests.
2. Make it visual. To help keep track of who’s receiving payers’ requests for records and who’s releasing them, create a flowchart, Crump recommends. This will serve as an easy reference and make opportunities for process improvement more apparent.
3. Make a note. Ensure your process captures clear information on response timelines and deadlines, Crump says. Also make sure you have a method for noting that an account was audited prior to claim payment. This will make it easier to track how many claims are being subject to pre- and post-payment audits.

For more information, see "Getting ahead of pre-payment audits" in the December 2020 issue of HIM Briefings.