2. Copyright Health Decisions, Inc.
2015
2
About Health Decisions, Inc.
Pioneering Specialists in
Group Health Care
Post-Payment Administration
For Over 25 Years
Respect for Existing Procedures
Emphasis on Customization
Focus on Solutions
Customer Philosophy
3. What makes an audit successful?
Based on our 25+ years of audit experience,
successful audits are based on answers to
three basic questions:
1.Why are you auditing?
2.What are you auditing?
3.What audit approach serves your purpose?
Copyright Health Decisions, Inc.
2015
3
4. Why Audit?
Before starting any audit, know why you are doing it.
Audits serve three purposes:
1.Compliance
2.Control
3.Cash
Not mutually exclusive, just different.
What do you want to achieve?
NOT what does your payer allow?
Copyright Health Decisions, Inc.
2015
4
5. What are you auditing?
Payments Claim audit
People Eligibility/Enrollment audit
Process Site visit
Contracts Document review
Issues Custom analyses
Copyright Health Decisions, Inc.
2015
5
6. What audit approach
serves your purpose(s)?
Why are you
auditing?
The right tool for the job you want.
Random Sample
Audit
100% Data Audit 100% Data Audit
with Recovery
Pursuit
Compliance
Control
Cash
“Easy” Button Today’s
“Prudent Person”
New dimension to
audit results.
Expect resistance.
Copyright Health Decisions, Inc.
2015
6
7. Copyright Health Decisions, Inc.
2015
7
For More Information
Contact
si@healthdecisions.com
734-451-2230
Connect with me on LinkedIn
Add me to your circles on Google+
Like us on FaceBook
Follow us on Twitter