As healthcare begins to recover from the impacts of COVID-19 there are new challenges ahead as the Providers’ reprieve on managed care audits during the pandemic comes to an end. Industry observers expect a veritable alphabet soup of audit types — HEDIS (Healthcare Effectiveness Data and Information Set), RADV (Risk Adjustment Data Validation), MRA (Medicare Advantage Risk Adjustment), HIX (Health Information Exchange), CRA (Commercial Risk Adjustment), etc. — to increase, including audits focused on all the telehealth that occurred during the pandemic.
In short, for providers that had to scramble to implement new policies, practices, and technology during the pandemic, auditors aren’t going to let you catch your breath as, unfortunately for many, was evident during the 2021 HEDIS season.
New Telehealth Audits Underway
In February of 2021, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) announced that it is conducting seven different audits, evaluations, and inspections of telehealth services.
These audits will focus on telehealth usage by home health agencies and in Medicare and Medicaid populations.
Given that most providers expanded their telehealth capabilities during the pandemic, many providers can expect their Medicare or Medicaid billing relating to telehealth to be subject to OIG scrutiny.
Sharecare handles audits for providers so that providers can focus on what they do best: caring for their patients. Our audit services help you comply with any audit challenges you face, all year long.
Let the Experts Handle Your Audits
Sharecare takes the burden off your shoulders, communicating with the auditor Health Plan and other intermediary organizations, complying with all audit requirements, eliminating the stress tied to short-notice chart demands, and generally dealing with all audits promptly until completion of the audit.
With Sharecare as your partner, you can rest assured that all health privacy laws will be followed. Every Sharecare Health Provider Solutions employee is a Certified Release of Information Specialist (CRIS), and Sharecare ensures a process compliant with the Health Insurance Portability and Accountability Act (HIPAA).
We meet deadlines and exceed expectations, and our existing relationships with Health Plans eliminate calls and faxes.
Handling an Audit Without Outside Assistance is Not Worth the Aggravation
We likely don’t need to tell you that having your practice audited is never a welcome development. Not only does an audit carry the risk of monetary penalties, going through the audit itself is often daunting for practices.
There are strict procedures and timelines to follow, and the auditor may issue follow-up requests, demanding more time and attention.
Why accept these hassles when Sharecare can shield you from dealing with auditors? We handle all communications and unobtrusively take care of the work of responding to audit requests.
Year-Round Assistance
It’s an unfortunate fact of healthcare practice today: audits are a continuing threat year-round. While some audit types, such as HEDIS, are seasonal, other types are ongoing throughout the years. Likewise, some audits are routine, some are random, and others occur in response to suspected problems.
With audits an ever-present possibility, it makes sense to outsource a permanent solution. Just like you wouldn’t have your internists and nurse practitioners clearing snow with shovels and plows (you’d contract out for snow removal), it doesn’t make sense to divert providers’ time and energy to audit compliance.
Sharecare has the expertise, tools, and experience to handle health care audits. The temporary government and commercial reprieve from audits may be over, but with Sharecare as your trusted ally, a permanent reprieve from audit aggravation is yours to enjoy.