Health Information Management

News: Audit activity set to pick up pace in 2016

CDI Strategies, April 28, 2016

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This will be a big year for audits between the new Recovery Auditors hitting the ground later this year, the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) now focusing on the 2-midnight rule, and a continued increase in managed care audits, Dawn Crump, MA, SSBB, CHC, vice president of audit management solutions for CIOX Health in Alpharetta, Georgia, told HIM Briefings in its May edition.
Recovery Auditors will likely spend 2016 focusing on diagnosis-related group (DRG) audits and medical necessity reviews. These audits will likely focus on reviewing medical necessity for procedures, tests, and treatments in relation to what the Payment Integrity Manual states should be captured in the health information. Records that do not capture information related to local and national coverage determinations will likely be the low-hanging fruit if the Recovery Auditors are approved to focus on these reviews, Crump says.
Also, auditors are getting up to speed on ICD-10 now, which means organizations should also be taking steps to ensure it is ready when the time comes, Crump says. "The basic audits are still ongoing, but most providers I have spoken with are cautiously optimistic because they are not seeing ICD-10 denials yet," says Crump who warns that ICD-10 examinations should pick up in the latter half of 2016. 

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