At the Margins

How Cedars-Sinai saved $76M with a simple audit strategy

by Robin Brand and Sophia Duke-Mosier

Feeling attacked by audits?

Today's revenue cycle leaders often mention feeling attacked by the "regulatory tentacles," of government or non-audit requests at multiple entry points along the revenue cycle. The range of these audit types are seemingly endless, from RACs to MACs, LCDs, NCDs, QIOs, and audits from the Office of Inspector General--with revenue placed at risk from each one. Responding to, and mitigating, these audits can come at a high cost, requiring leaders to divert time and focus from other revenue cycle tasks to ensure compliance.

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How your organization can feel empowered with an organized response

Seeing the struggle to keep up with audit requests, Cedars-Sinai's Director of Revenue Integrity purchased a Government Audit Program (GAP) as part of its revenue cycle operations. All audit requests are entered into a centralized database, which  includes a detailed history of every government audit affecting the organization in the past seven years, such as line item denials on second-level appeals, internal self-audits, and external audits. Each month, the revenue integrity team generates a report that includes revenue permanently saved, revenue permanently lost, and revenue still in play, or under audit.

GAP's success has led Cedars-Sinai to increase the purview of the program and the database, which now includes information on denials and high-cost drugs. Overall, by combining the database with other aspects of the organization's robust revenue integrity program, Cedars-Sinai has avoided $76 million in lost revenue.

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