Healthcare Audits Highlight Benefits of Risk-Based Auditing Solutions


It’s no secret that financial penalties for hospital-acquired infections or other injuries occurring within healthcare facilities can have disastrous consequences on a hospital’s bottom line. But some healthcare systems face these repercussions as a result of simple coding errors, not actual injuries to patients. This year (2018), 751 hospitals are facing Medicare payment cuts from the federal government.(1) However, at least one hospital claims that medical coding errors—not actual patient injuries—are to blame for these penalties.(2) To lower risk as much as possible, healthcare systems should utilize risk-based auditing software solutions such as those offered by Fi-Med Management.

All hospitals facing disciplinary action stand to lose a significant amount of money from Medicare reimbursements over the next year. The federal government has announced a 1% cut to Medicare payments for each individual patient’s stay at the 751 facilities.(1) Hospitals on the list also face reductions in the amount of Medicare funds allocated for teaching medical residents and caring for low-income individuals.(1) A full 425 of the hospitals penalized in 2018 were also fined in 2017.(1)

Representatives from one hospital, Southern Maine Health Care, claim that employee coding errors are to blame for the financial penalties levied against the hospital this year. As a result of these coding errors, a medical condition was incorrectly added to the health records of several patients.(2)

Adrian Velasquez, president, CEO and co-founder of Fi-Med, says, “This should be a huge wake-up call for healthcare systems around the country. It’s hard to understate the huge impact these financial penalties will have on the 751 hospitals, including those whose errors actually resulted from medical coding mistakes. Healthcare systems can’t let something as simple as a coding error result in the loss of large amounts of revenue.”

Risk-based auditing software, such as REVEAL/md, identifies compliance risks early so that corrective action can be taken before audits occur. Utilizing this type of solution is key to helping hospitals avoid costly mistakes.



April 6, 2018


Topic Area: Press Release


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