What Makes a Best-in-Class Recovery Audit Firm in Healthcare?

Written By; David Hewitt, RVP of Sales – East

What are the basics for a Recovery Audit provider?

At minimum your Recovery Audit firm should be checking all the following boxes.

  • Working offsite/Remote access
  • Online claims delivery
  • Data files (AP, Vendor Master, PO, Receipt)
  • Data security
  • Healthcare experience
  • No initial investment to get started

What are the attributes of a Best-in-Class Recovery Audit firm?

It is not enough to settle for a firm that simply checks the boxes.  The following list outlines the attributes you should look for in a best-in-class Recovery Audit provider to ensure the best results and the highest levels of partnership.

  • Strong data security — ¬Provider should demonstrate strong security measures including encrypted data, SSAE16 Secured Data Centers, HIPAA Trained
  • Industry expertise and benchmarking — Healthcare is a unique industry, and your Recovery Audit provider should demonstrate deep expertise.  A few of the insights they should provide are as follows:

o    What are your healthcare peers doing to address issues like yours?
o    How do you compare to other healthcare systems?
o    Best practices to patch gaps leading to financial leakage
o    Proven industry methods for driving cost-saving efficiencies

  • Insights and visibility — Provider should offer meaningful root-cause analysis and recommendations. Some of the key insights should include:

o    A listing of which suppliers (and staff) are not complying with processes
o    A clear understanding of why and where dollars are falling out of the process
o    Strong recommendations for how to positively impact the problem
o    A focus on corrections and not collections

  • Cost-savings opportunities — As a result of the audit, you should gain a clear outline of where to save dollars in your annual spend that are not simply related to recovery.
  • An up-to-date scope.  Your best audit results will come from a scope that hovers around 90-days and provides real-time feed back.
  • RNI, INR Reconciliation — Your audit should support the RNI (receipt not invoiced) and INR (invoiced not received) reconciliation.  This is critical for healthcare.
  • Additional services — Ensure your provider has other solutions beyond Recovery Audit otherwise they will not be incentivized to help you fix your problems.
  • A healthy vendor database — Provider should have an up-to-date database of suppliers to help clean your vendor file and to aid in outreach to suppliers.
  • A strong partner ecosystem — Provider should be connected to other industry providers to help gain a wider view into how to fix your network’s larger issues.
  • A client portal — Claims should be delivered through an online portal with claim upload capabilities, drill down capabilities, in-depth reporting, communication, ease of use and 100% claim administration.
  • A full-time staff — Your auditors should be a team of full-time employees that are paid a salary or hourly wage to ensure they are consistently auditing all ranks of your vendor file and AP transactions history without competing incentives or prejudice.

For more information regarding the benefits of using a Recovery Audit to help boost your hospital’s bottom-line or to drive new insights and visibility into your cost-cycle, contact SpendMend today.

Top 4 IT Optimization Recommendations for 2021

Written by: Evan Katzman, OptiSave

Demands on health systems’ Information Technology (IT) teams continue to grow exponentially. ERP and EMR implementations, integrations accompanying mergers and acquisitions, and securing an ever-expanding digital footprint are just a few of the challenges being faced by these teams – all while keeping the environment secure and running smoothly. Over time, these demands have forced many health systems to focus on ensuring coverage vs. optimization, ultimately leaving significant dollars on the table. We compiled 4 tips for you to help optimize your IT environment going into 2021, which in turn will prevent you from leaving those dollars on the table.

Top 4 IT Optimization Recommendations for 2021:

  • Security – Ensure you have an effective IT security plan based on Zero Trust.  Typically, we see either a best-of-breed or all-in, single vendor approach.  Additionally, we recommend an annual security audit and test, preferably with a different audit vendor each year.  Addressing vulnerability and PHI security is a key priority – each firm has a slightly different methodology which may uncover new issues. Also with the issues surrounding the SolarWinds network management software breach, country of origin risk should be considered.
  • Roadmaps – Update your technology roadmaps.  We recommend developing a plan that supports the organization’s digital migration and achievement of operational goals.   There are many unknowns as we start 2021 – the pandemic and related costs, patient volumes, funding availability for current and future projects, regulatory changes etc.  The need for care providers to be nimble and flexible is paramount.
  • Enabling Technology  – With the rapid technology evolution we’ve seen over  the last few years, e.g.,  voice enablement, cloud services, wearable medical devices, artificial intelligence and structural changes (telehealth, telemedicine and telework), we are entering an era where traditional structure for providing services is rapidly changing. All providers will be deploying enabling technology, resulting in health services increasingly performed and supported remotely – with amplified focus on tracking analytics including patient satisfaction, outcomesstaff performance, and revenue impacts.
  • Rely on Subject Matter Experts – Because of the changing environment and complexity of new technology  – and associated licensing and vendor agreements – it’s even more critical to utilize and collaborate with subject matter experts on your strategy, sourcing, implementation and support.

Implementing these 4 tips into your health systems IT environment is a big step in the right direction. We hope this helps you optimize your IT environment in 2021 and in the future to come.