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3 Tips to Justify Your Need for Auditing Resources

Posted by Samantha Champagnie on Apr 12, 2017 7:42:43 AM

In her blog post, "2 Things HIM Leaders Wish Their Revenue Cycle Peers Knew," Andrea Romero, SVP of HIM Operations at himagine solutions, challenged HIM leaders to become more visible within the revenue cycle function to help improve awareness of the importance and challenges associated with the HIM department. This prompted me to reflect on some of the feedback I receive from clients who are interested in utilizing companies like himagine for audit services. In many cases the client has a desire to go beyond a traditional and episodic compliance audit by developing a more comprehensive approach that addresses individual coder performance on an ongoing basis. Inevitably, this desire is tempered by the fact the HIM department does not have the funds budgeted to initiate such a program and the thought of achieving approval from the senior levels of the revenue cycle organization for this funding seems overwhelming.

As Andrea stated in her blog, the onus is on HIM leaders to communicate more effectively with their revenue cycle managers and peers to help improve the understanding of what is needed to drive better performance in the department. But how? As someone who has worked as a revenue cycle executive for several provider organizations and now heading up the audit team here at himagine, I feel I bring a unique point of view to this matter. Here are a few thoughts for you to consider.

1. Speak their language. To communicate effectively you must know your audience. What information resonates with them? Revenue cycle leaders are analytical and numbers driven. Terms such as "improved compliance" or "better information governance" that mean a lot in HIM don't mean as much to revenue cycle leaders as terms such as "positive return on investment (ROI)," "reduced operating costs," and "reimbursement optimization." Which leads me to my next point....

2. Build a business case. So they like numbers, well then give them numbers! But how? Building a business case is not as daunting as it sounds. If you are working with a third party for auditing services, ask them to help you build a financial case. Here at himagine, clients who have undertaken performance driven audits for us have experienced an ROI of 10 to 1 and reduced under coding by 42% on average. Any reputable provider of coding audits should be able to develop a business case for you based on your specific needs. If they are unable or unwilling, then you should find someone else to help you.

3. Present your case. Now you have a better understanding of your audience and a credible business case, but unless you present your case effectively it will all be for naught. This is not a time for simply sending an email to your head of revenue cycle or CFO summarizing your position. I highly recommend scheduling a formal meeting including all of the keys stakeholders in your organization that have influence on this type of project. For the presentation itself, besides the obvious need to share the metrics from your business case, it is critical that you provide the right context for your meeting and what specifically you need approved to achieve the results you are projecting. Start the meeting with the "why" behind your project. This will give everyone in the room the appropriate context. Next, share specifics from your business case. Lastly, make your formal request and close for commitment. Closing can be difficult for some individuals so here is question I would recommend raising at the end of the presentation, "In closing, given the strong need we have identified to pursue a more strategic auditing program to drive improved coding quality and the business case where we have quantified the financial impact this program will have on our business, is there any reason we cannot begin this project immediately?" This will prompt discussion among the group and push the momentum in your direction.

Was this insight helpful? I would love to hear any feedback you might have.

Topics: Audit