In a session at the Becker’s Hospital Review 4th Annual Meeting in Chicago on May 10, Carol Conley, director of audit and compliance for CoxHealth in Springfield, Mo., asked attendees to reexamine their auditing process, and divulged six secrets to developing and maintaining an effective hospital internal auditing system.
1. Document everything. Ms. Conley had a simple rule: “If it isn’t documented, it didn’t happen; if it didn’t happen, you can’t bill for it.” She emphasized the necessity of staff members keeping accurate and complete paperwork as the foundation for a successful audit.
2. Get auditors. Ms. Conley offered advice for building an auditing staff. She recommends having auditors specialized in nursing audits, physician audits and billing issues, and only hiring auditors with experience. Ms. Conley stressed the importance of hiring auditors able to take initiative and adapt quickly to changes; ones who realize “this is not a cushy desk job,” she said.
3. Get the auditors what they need. Auditors need the right equipment and the right access to do their job, said Ms. Conley. They need meeting rooms, fast computers and other standard office equipment, and administrators need to add auditors’ salaries, mileage expenses, training and other costs into the hospital’s budget. In terms of access, auditors need to be able to access “pretty much everything you have,” she said, including all hospital systems and the hospital’s chargemaster.
4. Figure out what to audit. One of the most important steps is to determine what to audit within the hospital to use auditing staff and resources most efficiently. Ms. Conley pointed to three characteristics that warrant flagging for audit. These include risk (including tight regulations, a conflict with the hospital’s mission or values and possibility of detection), volume and dollar amount. She also recommended looking at patient complaints, outliers or anomalies, reimbursement denials, changes in billing practices and new services.
5. Develop an audit plan. Ms. Conley recommended developing an audit plan to efficiently manage a hospital’s audits. She suggested holding annual (or more frequent) meetings with the auditing team to review the work plan, audit sources and concerns from hospital staff and management, as well as identify risk areas and prioritize areas for audit.
6. Know when to stop. Auditors “have to know when to stop,” said Ms. Conley. She advised hospital administrators to make sure auditors understand the risk and the liability to the hospital when they find a significant issue in the hospital’s operations, and know when to report it under attorney-client privilege.
