Audits are a routine but stressful part of your company’s business. The software that guides and manages your utilization review (UR) process should help your organization be ready for regulatory scrutiny at any time.
Insurance companies may be audited for rate-setting or claims practices, and 18 states have auditable utilization review licensing requirements. Sometimes audits are bundled, and sometimes they focus on a specific compliance area. Audits may be random or scheduled well in advance. In some cases, the regulator requires a company to submit data for examination before making a decision to audit. In many states, the likelihood of audit and risk of penalty are very high.
Protect Your Company With Internal Audits
Regular internal audits can protect your company from audit findings that lead to fines and penalties. The best UR software, like ReviewStat® by UniMed Direct, collects data, tracks processes and reduces user error to help companies stay compliant. The software should enable users to access data instantly and manipulate and report it in a way that gives leadership a clear line of sight into real-time quality and compliance.
Monitor & Refine
The data obtained through UR software equips leaders with the information needed to guide the best use of resources and identify treatment categories that are frequently denied or always approved (think compliance risks).
UR data also helps analyze staff workload and performance. It indicates how much work employees are able to do, how long it takes and the quality of their output. It provides a decision trail for the work that happens within the system. The software should generate quality-assurance reports that help management prepare for an audit.
The best utilization review software is built around speed and compliance. It is customized and configured to facilitate frequent internal checkpoints and provide internal controls for your operation. A software system designed to fit your company’s workflow is the best way to make sure you’re operating in compliance and consistently reach your quality goals.
If you have the right software, audits will feel like business as usual. If you don’t, it’s time to assess your software options.