Society and its institutions need to be in a constant search for the quality of the services offered, especially if they are related to the well-being and quality of life of the population. Therefore, understanding how process auditing improves customer service operators of health plans is essential.
This type of systematic evaluation can play an essential role in improving the sector and its organizations, which is something that will ultimately bring benefits not only to companies, but also to beneficiaries. Check out the content below and find out how this happens!
What is the role of process auditing?
An audit is a set of examinations, carried out in a thorough and systematic manner, with the aim of evaluating the activities carried out in a company. It is a way of checking whether the processes are in accordance with what was previously planned or established, being implemented effectively to achieve the objectives.
In a health plan operator, auditors review accounting and financial aspects, such as cash flow and statements, in addition to medical bills, with the aim of finding any evidence of cheats or deviations, as well as failures, such as incorrect diagnoses with criminal intent or not, among other points.
Why do operators carry out audits?
Operators spontaneously submit themselves to audits, periodically and systematically, to avoid, for example, a possible drop in the assessment of the IDSS (Supplementary Health Performance Index), which plays a fundamental role in the ranking of the ANS (National Agency of Supplementary Health).
However, there are other important reasons. As we said, it is a crucial alternative to finding fraudulent actions or process errors that generate losses, in addition to enabling a structural review of the business, if necessary. Thus, it is possible to carry out a management sustainable, improving the quality of services offered and strengthening the operator's brand in the market.
What is assessed in the operator audit?
In health plan operators, there are some items that are evaluated in the audit with greater frequency and in greater detail. These include monitoring expenses and checking medical disallowances, for example, in addition to identifying chronic beneficiaries who require high costs.
Other points are the verification of fraud, reducing the accident rate, the analysis of harmful conduct carried out by health professionals or their providers and the assessment of the care and epidemiological performance of their care network, indicating the need for possible revisions or renegotiations.
How does a management system help with auditing?
Management software helps with auditing in several ways, as it promotes the centralization of data and facilitates the insertion of accounting elements, much more efficiently than Excel spreadsheets. Furthermore, with this tool, it is possible to automate processes, minimizing fraud and increasing control over deadlines and obligations.
As you can see, auditing processes improves the service of health plan operators, making their operation leaner and less prone to important errors, which could harm the institution.
Did you enjoy learning how process audits improve service for health plan operators? So, also check out the our article on how to choose the best software for managing healthcare costs!
