SAI Global Compliance Predicts Major Trends in Healthcare Governance, Risk ...
Healthcare GRC Trends for 2012 include:
Bounty Hunter Threats Continue to Increase: As personal greed has long been the primary motivator behind fraud and abuse, regulators and private payers are financially motivating third parties, to help identify and prosecute offenders. Examples of this can be found in the RAC for Medicaid and pending pre-payment RAC audits, as well as audit contractors hired by private payers to conduct post-payment audits. Providers need to prepare themselves for the increasing volume and complexity of audits.To prepare, compliance departments can establish a system of record for centrally managing all revenue recovery audits and utilize automation to cope with the complexity and increasing volume of these audits. The appeals process for every audit type is unique. An automated “virtual audit coordinator” can be used to establish accountability and ensure that critical dates are not missed during the appeal process. If not managed properly, missed dates lead to lost revenue.
