Preparing for Audit Research Paper

Preparing for Audit Research Paper

Description/Paper Instructions

Preparing for Audit Research Paper

Preparing, Audit, Research, Paper

When responding to your classmates, recommend collaborative techniques that might contribute to their audit preparations. Provide specific examples to support your response.

Post #1

Preparing for any audit can cause an organization to instantly be on the defensive or feel as if they have done something wrong. The first thing I would do as a healthcare leader would be to emphasize to those affected that they are not trying to get anyone in trouble or there needs to be a shift in blame.

I would reiterate that this is being done to improve future quality and to ensure that the organization is billing correctly. This compliance is very important for the sustainability of a health organization and an audit proves (or disproves) that this aspect of the care is being done correctly.

Another preparation method would be having all potential document requests already prepared. The timeliness of these submissions will make speed up the process and help the auditors to do their jobs easier. CMS says RACs can make patient-status judgments going back six months as long as hospitals have submitted their claims within 3 months of patient treatment (Stein, 2015). Having this information going back in the allotted time frame will be important for quick retrieval of these documents.

Collaboration is crucial if this process is going to occur with the least amount of resistance. Having all providers educated to the process and why this is occurring will be important so they will assist with maximum compliance. Collaborating and communicating with the provider groups is important because I have found in my own experience that people will push back on these sorts of processes when they do not fully understand why it is occurring.

That is why educating all parties involved with this audit will be such an important part of this process. A hospital administrator has the resources and network to provide and promote this education and ultimately improve the healthcare facilities billing and coding quality.

Stein Michelle M. (2015). CMS Limits RAC Audits On Hospital Status Reviews. Inside CMS, 18(1), 19.

Post #2

The Recovery Audit Program identifies overpayments or underpayments on claims for services under Medicare (Castro, 2018). The Recovery Audit Contractors (RAC) carry out the actions for the audits of the program in their assigned regions of the United States (Castro, 2018).

As a healthcare administrator in a hospital environment I would want everyone to have knowledge of the audit process and any concerns, but I believe that having a designated staff member, or team, who can best prepare the organization is key. Having a team, or team member, who can create a compliance plan and be familiar with the audit process would be beneficial.

I would utilize information from the RAC to gain insight on how to anticipate what will be expected by the RAC. For example, the RAC quarterly newsletters that identify their top concerns can help identify what should be a top focus for your organization when reviewing processes and corrective action that may be necessary (Castro, 2018). The RAC also works to ensure that their policies are understood clearly to ensure standardization and prevent various interpretations (Castro, 2018).

The team would ideally have an understanding of how to utilize the RAC web portal for communication, which can make the process more efficient and effective. Ideally, they would be able to obtain and provide any requested information quickly when the need occurs. Learning from other audits to prevent future audits would be a goal. Reviewing past claims in audits and possible causes can give an idea of what training or strategies should be implemented to prevent future errors (Stillwell, 2018).

References

Castro, A.B. (2018). Principles of healthcare reimbursement (6th ed.). Chicago, IL: American Health Information Management Association.

Stillwell, K. (2018, January 5). Be Prepared for a Recovery Audit Contractor Audit. Retrieved from https://www.thedoctors.com/articles/avoid-being-put-on-the-rac-be-prepared-for-a-recovery-audit-contractor-audit/

RUBRIC QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points:  Student failed to submit the final paper. 20 points out of 50:  The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50:  The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately.  Elements of the required response may also be lacking. 40 points out of 50:  The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples.  The answer is complete. 50 points:  The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples.  No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points:  Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points:  Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points:  References to scholarly sources are occasionally given; many statements seem unsubstantiated.  Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points:  Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented.  APA 6th Edition is used with only a few minor errors.  There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points:  Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented.  APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points:  Student failed to submit the final paper. 5 points out of 20:  The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors  10 points out 20:  The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20:  The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points:  The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points:  Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements.  The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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