Best Senior Living Homecare Agencies | AspectN

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AUDIT RISKS

• ASSOCIATED WITH HOME HEALTHCARE AGENCIES

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According to the Office of Inspector General
(OIG) Findings Report, 90 of the Comprehensive
Error Rate Testing (CERT) audit denials of
high-risk home health agencies were based on
insufficient documentation. With the Affordable
Care Act induced additional provisions, Home
Healthcare Agencies have become a target of
frequent audits. Types of Audits that Home
Healthcare Agencies go through Home Healthcare
Agency has to go through various audits. Being
proper documentation or patient health, agencies
need to be prim and proper. Some of these audits
are Risk Adjustment and Medical Record Reviews
(MRRs) Health plan payers or insurance agencies
conduct this audit to validate the claims made by
patients to rule out any fraudulent
claims. Health Effectiveness Data Information
Set (HEDIS) Reviews A review is conducted by the
Payer or Health Plan agency to check the quality
of treatment and care their patient is getting.
It ensures that the Home Healthcare Agencies
effectively perform the core tasks.
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Diagnosis-Related Group (DRG) Payment Integrity
Reviews Diagnosis-Related Group (DRG) classifies
different hospital cases to various codes. These
codes are verified to validate the claims made by
patients. Care and Quality Improvement (CQI)
Audits Patients sometimes dont realize the
severity of the disease and might need preventive
attention to avoid hospitalization. Healthcare
agencies and Health plan providers collaborate
to check these cases to reduce medical costs and
enhance patient safety . Five-Star Program
(Medicare Advantage) A quality care audit wherein
Healthcare Agencies are rated according to the
service provided and client care.
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Reason for Home Healthcare Audit to be
institutionalized
A medical audit has importance for both home
healthcare agencies and healthcare plan
providers. Audit keeps a check on overpricing and
care provided to patients. Audits like Care and
Quality Improvement (CQI) Audit and Five Star
Program help improve the services provided to
patients. Preparedness needed in these
Audits According to the transcript of an Audio
from the Office of Inspector General (OIG) of the
United States Department of Health and Human
Services (HHS), Good documentation promotes
patient safety and quality of care. Complete and
accurate medical recordkeeping can help ensure
that your patients get the right care at the
right time.
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Proper Documentation Proper documentation
involves proper handling and maintaining data.
Keeping patient data safe and updated is the
key. With data recording shifting to digital mode
and solution software coming into the picture,
the error rate comes down to zero. Error
Correction from the previous audit Rectification
of error is the key in any business. An audit
helps in finding out the errors. With proper
management and remedial measures, error-proofing
can be done reducing the scope of any
discrepancy in the next audit. Updated
Documentation Maintaining patient data correctly
and keeping it updated is the key. A Home
Healthcare Agency needs to constantly edit
patient data and add new data to avoid missing
out on any patient and keep the data
updated. Challenges faced by Home Healthcare
Agencies in Paper-based manual data entry With
the growing digital world, paper-based home
healthcare agencies face a lot of limitations.
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Repetitive Tasks With the paper-based model,
planning is challenging. The conflicting job
roles of a Home Healthcare Agency employee may
increase the repetition of work. Same data
recorded twice or more times may have an impact
on cost, but it also takes a toll on the mental
health of the employees. Scope of Error Manual
entry attracts personal bias and judgment. These
judgments may sometimes lead to errors in data
entry. With machine-based recording, these errors
come down to zero. Software designed for this
purpose provides better and more accurate data
recording. High Cost Be it minor expenditure of
stationery or major costs of error in recording,
a paper-based model attracts huge costs. This
includes not just direct cost, but indirect cost
as well through an error in reporting leading to
audit failure. This takes a toll on the
intangible asset of goodwill earned throughout
the business.
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Nurse Burnout Being engaged in monotonous and
repetitive tasking, nurses might not be able to
give full attention to the patients. With the
increased workload of data recording, nurse
dropout and burnout rates tend to increase over
time. Quality Healthcare Delivery The core task
of any healthcare agency is to provide quality
care to patients. With the employees fixated on
no productive tasks, it may impact employee
performance and might have an impact on audit
reports checking the quality of Home Healthcare
Agency services (Five-Star Program).
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Impact of Audit Failure on a Home Healthcare
Agency
Negative impact on Goodwill An audit is a check
to verify the reliability of something. With
audit failure, customers tend to doubt the
agency and might even change their preferred
healthcare agency. Goodwill of the agency
accumulated over years of service vanishes
soon. Customer Loss Healthcare runs based on
trust. With audit failure, customers tend to lose
trust in the organization and may not feel safe.
A sense of being cheated might disturb them and
persuade them to change their desired healthcare
agency. Heavy penalty With non-compliance and
audit failure, a heavy penalty is levied on the
agency. This increases the overall cost that the
agency might suffer apart from client loss.
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Conclusion
Home Healthcare Agencies need to operate with
care and comply with all regulatory guidelines.
Keeping track of these guidelines is a cumbersome
as well as an exhaustive task. Shifting to
technology-driven solutions is the best
option. Based on a Clinical Protocol Approach,
Aspect N helps Home Healthcare Providers monitor
Clinical Adherence, Reduce the probability of
manual errors, and streamline workflows to
enable better productivity and compliance with
regulatory norms. AspectN is a transformation
partner and a leading provider of customized,
cloud-based, and innovative platforms and
software solutions. We can partner with you in
your journey of facilitating top-notch home
healthcare services to those in need. While you
hone your focus and success story in the field,
we will create a strong tech-driven, secure, and
scalable solution in the background that will
help you evolve and grow ahead of your
competition.