“If you can’t measure it, you can’t change it.”
— Peter Drucker
Why Is a Strong Audit Program Important?
Identify underpayments
Build trust with stakeholders, such as governing bodies, through accountability metrics
Decrease cost per claim
Increase average reimbursement per patient encounter
Determine risk
Create operational efficiencies
nCite™ looks at 23 critical elements from the pre-bill and post-bill process
PRE-BILL = 6 Elements
CODING = 11 Elements
POST-BILL = 6 Elements
Clients can use the feedback for operational improvements to assess risk, quality, and efficiencies.
Pass or fail grade on each element.
Drill down to individual employees.
Utilize feedback on each element that failed.
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Primary care physicians may be leaving over $200,000 on table each year due to the underuse of Medicare's prevention and coordination codes. A study concluded: "Primary care physicians forego considerable amounts of revenue because they infrequently use billing codes for prevention and coordination services despite having eligible patients and providing code-appropriate services to some of those patients."
Sumit D. Agarwal, Sanjay Basu, Bruce E. Landon. The Underuse of Medicare's Prevention and Coordination Codes in Primary Care: A Cross-Sectional and Modeling Study. Ann Intern Med.2022;175:1100-1108. [Epub 28 June 2022]. doi:10.7326/M21-4770
Of the $498 million in Medicare overpayments identified in HHS-OIG audit reports issued during our audit period that CMS sustained, CMS reported that it had collected only $272 million (55 percent) and that it had not collected $226 million (45 percent). Further, CMS provided documentation sufficient to support that it had collected only $120 million of the $272 million. CMS did not provide adequate documentation to support that it had collected the remaining $152 million.
“CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits.” U.S. Department of Health and Human Services Office of Inspector General (July 2022)
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We look forward to connecting with you on how nCite’s audit solution can keep you from leaving money on the table, and help you build trust among stakeholders.
