Why Investing in Internal Auditing Tools is Key to Reducing Coding Risks and Financial Losses

As the healthcare industry faces increased scrutiny, especially in medical coding accuracy and regulatory compliance, recent surveys reveal that many professionals are concerned with issues like upcoding, audit discrepancies, and the integration of artificial intelligence in coding practices. According to a Black Book survey, 90% of HIM professionals believe that upcoding is a significant ethical concern, while 85% say that discrepancies identified during coding audits often lead to denied claims or repayment demands due to system complexity.  

The Case for Internal Auditing: Transparency, Efficiency, and Risk Reduction

A comprehensive internal audit monitoring tool is no longer optional but a necessary investment to safeguard a healthcare organization’s bottom line. The stakes are high: as the survey indicated, issues with coding accuracy and compliance not only increase financial risks but also strain staff who must constantly address discrepancies and audit responses. MRO’s tools offer healthcare organizations a way to monitor compliance audits, track corrective actions, and analyze unusual billing patterns. These solutions help simplify a complex and dynamic environment, enabling healthcare providers to focus on delivering the best possible care without compromising compliance. 

How MRO’s Internal Audit Monitoring Tools Make a Difference

1. Audit Scorecards and Real-Time Feedback
MRO’s internal audit monitoring tools enhance compliance by allowing organizations to track and assess their audits using comprehensive scorecards. Given that 85% of HIM professionals cite coding audit discrepancies as a leading cause of denied claims or repayment demands, real-time feedback through internal audits is crucial. This capability helps providers pinpoint discrepancies early, reducing coding errors and ensuring timely payment—ultimately minimizing the administrative burden of addressing complex audit outcomes. 

2. Streamlined Audit Management
Managing billing compliance audits and tracking corrective actions across multiple teams can feel overwhelming. MRO’s tools offer a centralized dashboard, allowing users to view active audits, track progress, and make updates all from one screen. This functionality is especially critical as the industry prepares to transition to ICD-11, a shift that 80% of HIM professionals fear will increase coding errors. With the streamlined management provided by MRO’s audit monitoring tools, organizations can simplify the audit process, reduce staff stress, and improve training based on audit findings. 

3. Automated Operations for Improved Accuracy and Reduced Risk
By automating routine tasks, MRO’s internal audit monitoring tools help reduce errors and improve compliance accuracy. In an environment where 18% of HIM professionals report employer pressure to engage in questionable coding practices, automating checks and balances within the audit process can safeguard employees from unethical demands. Pre-scheduled audits and triggered follow-ups ease the manual workload on staff, allowing them to focus on high-priority tasks. This approach enhances both performance and compliance while minimizing human error. 

4. Data-Driven Insights and Root Cause Analysis
MRO’s internal audit monitoring tools are designed to help organizations go beyond surface issues, diving deep into data to identify risk trends and root causes of discrepancies. With MRO’s data analytics, organizations can assess risk factors by individual, code, or modifier, enabling them to correct issues proactively and reduce the likelihood of complex audits and their repercussions. 

5. Enhanced Compliance with Specialty Benchmarking
To stay competitive and compliant, MRO’s internal audit monitoring tools include specialty benchmarking, helping organizations set realistic and measurable compliance goals. Benchmarking aligns organizational practices with industry standards, a necessity given that over half of HIM professionals believe bundling or unbundling services can either underestimate care or risk billing fraud. With specialty benchmarking, organizations gain a clear view of where they stand, which instills confidence that coding and billing practices are accurate and transparent, avoiding the ethical and legal risks of bundled service coding. 

MRO’s Internal Audit Monitoring Tools: Professional Audit Monitor and Institutional Audit Monitor

MRO offers two specialized internal audit monitoring solutions to address the unique needs of healthcare organizations: 

• Institutional Audit Monitor is tailored for institutional compliance needs, equipping hospitals and large health systems with advanced tracking and auditing capabilities. The tool’s central dashboard enables users to manage all active audits from one interface and allows you to compare to 90 pre-defined risk areas, including RAC, OIG, and PEPPER. Institutional Audit Monitor also includes benchmarking features, allowing hospitals to measure their performance against industry standards and ensure compliance across a large-scale organization. 

• Professional Audit Monitor is designed to streamline coding audit management, helping organizations oversee audit scorecards, manage corrective actions, and improve billing accuracy.  Professional Audit Monitor allows you to schedule audits in advance and set automated follow-ups. This tool enables teams to monitor audits from physicians, coders, departments, practices and specialties while tracking real-time feedback to enhance the accuracy and efficiency of audit processes. 

With these two solutions, MRO provides a comprehensive suite of tools that empower healthcare organizations to protect their revenue, maintain compliance, and achieve operational excellence in an increasingly complex healthcare environment.