Ep. 47 - Audits with Brenda Edwards

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan delves into the complex and pressing topics of audits, compliance, and documentation. Joined by expert Brenda Edwards, who has extensive experience in healthcare revenue cycle, they discuss the rising frequency and importance of audits, sharing insights and real-world examples, including metadata and audit trails. Brenda emphasizes the need for thorough documentation to support services billed and advises on how to handle audit letters without panic. Practical advice is given to ensure that organizations remain compliant and prepared for inevitable audits. The episode also highlights the need for internal and external audits, the importance of having a compliance plan, and the potential benefits of integrating thoughtful automation into the audit process.

00:38 Meet Brenda Edwards: Background and Expertise
00:52 Understanding Audits: Who, Why, and How
00:58 Real-World Example: Incident Two and Split Shared Services
01:16 Practical Takeaways: Responding to Audits
01:26 Disclaimer and Scope of Discussion
01:59 Starting the Conversation with Brenda
02:09 The Growing Importance of Audits
03:03 Brenda's Journey in Auditing
09:54 Compliance and Documentation: Best Practices
10:58 Cardiology Audit Case Study
11:44 The Role of Metadata in Audits
16:18 The Consequences of Improper Access
26:02 The Long-Term Impact of Audits
26:52 First Offense Penalties and Compliance Plans
28:43 Case Study: EHR Upgrade Issues
30:09 Legal Implications and Repeat Offenders
31:57 Handling Sanctioned Providers
34:04 Responding to Audit Notifications
34:33 Educational vs. Recoupment Letters
42:07 The Importance of Documentation
46:39 Final Thoughts and Takeaways