BCA is deeply attuned to the unique complexities and challenges that Rural Health Centers (RHCs) face. We recognize that these facilities are often the backbone of healthcare in their communities, providing essential services in areas where medical resources can be scarce. Our approach to medical compliance audits reflects this understanding, as we meticulously evaluate the adherence to healthcare regulations while considering the distinct circumstances of rural settings. These audits are crucial, as they ensure that even the most remote health centers maintain the highest standards of care and operation, safeguarding patient well-being and the integrity of rural healthcare delivery. BCA’s commitment to these audits underscores our dedication to supporting rural health centers in their mission to serve their communities effectively and efficiently.
We offer a diverse array of compliance audits to meet the needs of healthcare professionals in the rural healthcare setting which include but are not limited to:
- Family Practice
- Internist
- General Surgeon
- Podiatrist
- Orthopedic Surgeon
- Wound Care
- Hospitalist
- Behavioral Health Specialist
- Obstetrics and Gynecology
Common Challenges
- Understanding E&M Guidelines: Providers may lack current knowledge or training on how to apply the latest Evaluation and Management (E&M) coding guidelines, which can lead to incorrect billing and potential compliance issues.
- EMR Diagnosis Accuracy: Electronic Medical Records (EMR) systems may contain inaccurate or misleading diagnosis descriptions, which can compromise patient care and lead to billing errors.
- Balancing Competing Priorities: Healthcare providers often face the challenge of managing multiple priorities, from patient care to administrative tasks, which can impact efficiency and focus.
- Performance Metrics: Establishing and maintaining relevant performance metrics is crucial for providers to monitor and improve the quality of care, as well as to meet regulatory requirements.
- Risk Revalidation: Regular risk revalidation processes are essential to ensure that providers are adequately managing potential risks associated with patient care and healthcare operations.
- Navigating Value-Based Reimbursement: Transitioning to value-based reimbursement models requires a deep understanding of the metrics and strategies that drive quality care and cost efficiency.
- Continual Education and Training: Ongoing education and training for providers on these issues are vital for adapting to the evolving healthcare landscape and ensuring the highest standards of patient care.
Compliance Audits
- Ensuring Legal and Regulatory Adherence: Compliance audits are vital for rural health centers to ensure they meet legal and regulatory requirements, thereby avoiding potential legal penalties.
- Quality of Care: Audits help maintain high standards of patient care by identifying areas of non-compliance and enabling healthcare providers to take corrective actions.
- Fraud and Abuse Prevention: Through regular compliance audits, rural health centers can prevent fraud and abuse, which is crucial for maintaining trust and integrity in healthcare services.
- Financial Health: Compliance audits can safeguard against financial risks by ensuring that billing and coding practices comply with current laws and regulations, which is essential for the financial sustainability of rural health centers.
- Performance Improvement: Regular audits provide an opportunity for continuous improvement in healthcare delivery and patient outcomes by identifying performance gaps and areas for enhancement.
- Resource Optimization: For rural health clinics and critical access hospitals, compliance audits can help optimize the use of limited resources by ensuring that services are appropriately utilized and documented.
BCA Compliance Audit Target Areas
- Documentation Review
- CPT, HCPCS, and ICD-10-CM Code Evaluation
- Service and Diagnosis Capture
- Medical Necessity Validation
- Documentation Specificity
- Trend Analysis
- Authentication Timeliness
- Claims Review
- NCCI Edits Application