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60% of Healthcare Organizations Have Faced CMS or Payer Audit

Close to 60 percent of healthcare organizations surveyed by Sage Growth Partners have faced at least one CMS or payer audit.

CMS audit

Source: Thinkstock

By Fred Donovan

- Close to 60 percent of healthcare organizations surveyed by Sage Growth Partners have faced at least one CMS or payer audit.

Fifty-six percent of respondents said they have faced a CMS or payer audit more than once, according to the survey of 104 healthcare leaders at acute-care organizations conducted by Sage Growth Partners on behalf of Ingenious Med, a healthcare charge capture and practice performance analytics provider.

One-third of responding organizations have never been audited, and 8 percent were unsure or unwilling to share.

More than three-quarters of healthcare executives believe that charge capture is essential to their organizational success, but only 40 percent discuss it once or month or less.

One-third of responding organizations discuss charge capture weekly, while 18 percent discuss it twice a month, 8 percent discuss it daily, and 2 percent never discuss it.

“Optimizing the accuracy of charges is equally important, especially as CMS and private payers increase their scrutiny and number of audits. Not only is this critical to profitability right now, but as the industry moves from fee-for-service to fee-for-value, having accurate documentation of patient history and care delivery is also a critical part of the quality equation,” said Ingenious Med Chief Portfolio Officer Russell Smith.

Eighty-four percent of surveyed healthcare organizations rely at least partly on their EMR/EHR systems for charge capture, while 50 percent use it exclusively as their charge capture solution.

Twenty-eight percent of respondents use electronic, standalone solutions as part of their charge capture mix, while 27 percent use paper charge capture.

According to the survey, coders spend significant time tracking down the information they need from doctors.

Forty percent of respondents said the doctor and the coder should be equally responsible for capturing charges accurately. Nineteen percent said the responsibility rests more on the coder than the doctor, while 31 percent said the doctor should be held more responsible than the coder.

Only 6 percent said the doctor should be exclusively responsible, while 4 percent said the coder should be exclusively responsible.

Fifty-three percent of respondents said their coding department spends between 10 percent and 25 percent of their time tracking down information from physicians. Another 12 percent reported their coders spend as much as one-quarter of their time on these tasks. Twenty-eight percent said their coders spend less than 10 percent of their time tracking down information from physicians, and 7 percent did not know.

In order of importance, the most significant charge capture challenges included missing charges, charge lag, general inefficiency, integration with EHR or other technologies, coding errors, adoption adherence, and compliance.

Around one-third of respondents said their charges are captured within 24 hours of service. One-quarter said it takes one to two days, 35 percent say it takes three to seven days, 6 percent said it takes more than a week, and 2 percent said charges are captured in less than an hour.

One-third said that the time between charge capture and bill submission is one to three days. Forty-one percent said it takes four to seven days, 24 percent said it takes one to four weeks, and 2 percent said it takes more than four weeks.

A majority of respondents said that up to 20 percent of charges are either undercoded or overcoded.

More than half said between 1 percent and 10 percent of total charges are overcoded, and 14 percent said 11 percent or more of total charges are overcoded. Thirty percent reported that fewer than 1 percent or zero charges are overcoded.

Two-thirds of respondents reported between 1 percent and 10 percent of total charges are undercoded, and 20 percent said 11 percent or more of total charges are undercoded. Twelve percent reported that fewer than 1 percent or zero charges are undercoded.

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