The medical bill auditor must have practical knowledge and focus not only on costs and revenues, but also on the quality of care provided.
The importance of auditing medical bills is a thorough process that requires knowledge about medical diagnoses, procedures performed, inspections and their reports based on medical prescription materials, medications checked at the right time, various hospital expenses, reports from multidisciplinary teams, among others .
You may have already noticed that these factors require a high degree of commitment from the medical bill auditor, which is why he uses some resources to carry out his work successfully.
With this in mind, we have listed three essential resources for this performance to be complete. Are you interested? So, check it out right now!
Multidisciplinary knowledge
Due to its interdisciplinary nature, in addition to the concepts of hospital management and administrative management, auditors also need to have in-depth knowledge of health legislation.
Typically, the audit team is made up of the relevant department, a manager who has received medical training, or a nurse who specializes in auditing hospital bills. The objective is to evaluate the details of the process, whether care or management, which together form an integral part of the entire organization.
Basically, the method involves evaluating whether nursing practice meets established standards. To reach results, the auditor uses quantitative and qualitative methods to express opinions about the evaluation process.
After diagnosis, the audit will provide managers with valuable information that will guide the design of strategies to improve processes, correct non-conformities and reduce inappropriate behavior.
Operational approach
As the term already indicates, the audit directly concerns operation and maintenance procedures. The auditor can fully access the team's work, verify the level of assistance provided and assess whether it meets the minimum expected standards.
For example, indicators that can be used include patient medical history, performance evaluation, and patient-specific questionnaires. As long as the doctor agrees, the auditor can also suggest other more effective procedures for the patient.
Bill audit is also part of this mode which is carried out after the patient is discharged from the hospital, before the bill is sent to the operator.
The performance evaluation will assess whether there are any non-conformities that could result in other problems. To this end, a review must be carried out and the patient's diagnosis, treatment, exams, expenses and materials must be verified.
Analytical approach
The purpose of this approach is to promote an audit that carries out several detailed analyzes of the entire hospital environment in order to find obstacles and determine points that can be optimized. To achieve this, auditors must use indicators in alignment with managerial and administrative practices.
To make the auditor's work as efficient as possible, there must be independence and objectivity. In theory, this may seem obvious, but in practice, complications arise.
Therefore, auditors need support from the hospital organizational culture. The healthcare provider's clinical staff must be prepared to understand the importance of the auditor's role.
Do you have a few more minutes? Take the opportunity to get to know SAUDI, a software medical bill audit used by the largest health plan operators in Brazil and which has become the right-hand man of the auditor and/or medical bill analyst.
