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Presenter:
Si Nahra, Ph.D., President
January 29, 2015
Getting the Most Out of Your Audit
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
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
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
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
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
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

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Health Decisions Webinar: Getting the Most out of Your Audit

  • 1. Presenter: Si Nahra, Ph.D., President January 29, 2015 Getting the Most Out of Your Audit
  • 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