The audit is a relevant intermediary tool between the health plan operator and the doctor. If it is unsatisfactory, the risk of fraud or improper requests increases; on the other hand, audits that are too detailed demand a lot of company resources, distracting from their main focus — healthcare. This need for efficiency is why medical audit software is so important.

Classically, medical auditing is considered a medium full of forms, guides and printed documents. After all, as the operator's financial health depends on it, it is necessary that all processes are well documented. Have you ever wondered what it would be like to get rid of this entire bureaucratic scenario and have auditing at your fingertips?

This is exactly the proposal of medical audit software. In addition to digitizing the entire protocol involving the audit, it can also use artificial intelligence to bring greater automation to the area. Next, we will talk about the 5 main benefits of using these programs. Ready to discover the best that technology has to offer? Keep reading to find out more!

1. Automation of the audit flow

Let's face it: carrying out an audit of each guide sent to the health plan is unfeasible. Therefore, a strategy widely used by some operators is to use a screening method to check which requests should be audited. This reduces the number of guides, optimizing the flow and directing resources to the most necessary cases.

However, physical screening also brings harm to audit management: it is necessary to check guides, cross-reference the data provided for in the contract and define whether the cases fit or not. In addition to spending on logistics, human resources and office supplies, the practice also slows down audits and approvals.

Medical audit software performs this entire service instantly. Just feed it with permitted procedures, medicines and materials, and in which situations; When the doctor fills out the request form, the system will automatically check the authorization requirements. If he complies with them, the process continues normally. Otherwise, the software forwards the guide to the audit and only then does the auditor enter the scene.

2. Cost reduction

Auditing, in itself, is already a fundamental process in cost reduction in health plan operators. Studies indicate that, per hospital, audits can impact more than half a million reais per month. There are two ways, therefore, to optimize finances in audit management: reducing operational expenses and increasing effectiveness.

Medical audit software works both ways. Initially, by automating processes and reducing manual work, you cut personnel and rework expenses. Even though some medical billing systems are paid, therefore, in the medium term, you can recover the amount invested.

Effectiveness in carrying out audits occurs mainly by eliminating human error. When the initial screening is performed manually, some guides may be approved by mistake. With the use of well-structured software, this does not happen — it uses exact algorithms for authorization and performs screening in a completely computerized manner.

3. Practicality for auditors

With cloud-integrated medical audit software, auditors can access the process from anywhere: the program is capable of synchronizing data across smartphone, at the tablet or on the desktop. This brings greater practicality to your daily life, facilitates audits and increases the speed of opinions.

When it comes to audit management, this brings several advantages. Initially, the relationship with auditors becomes better due to the increase in resources; Depending on the situation, the number of auditors may even be reduced, due to the time saved. Furthermore, it is possible to avoid obstacles with the attending physician, because your requests are audited more quickly and efficiently.

4. Provision of data

The management of any sector in a health plan operator depends on substantial and reliable data. With them, it is possible to check early if there are any changes in the health network and what factors are related. This way, you can identify problems in the audit flow and correct them before they cause major disruptions.

Anyone who knows a statistics sector knows that the greater its scope, the more chaotic the data can become. Therefore, a significant amount of resources is often spent on data collection and analysis — reviewing medical records, checking statistics and using robust technologies, such as Big data, enter this work.

Medical audit software can perform all data provision instantly. It stores the issued guides, the rate of medical disallowances and the main causes of audit requests. This way, you can better organize your its management and focuses its resources on the operator's most essential areas.

5. Customization

As the audit process follows the flow of guides within the system, it is natural that the demands of software are different. Therefore, one of the main benefits of these systems is their customization: in an easy and direct way, it is possible to adapt form fields, templates and templates to the reality of each operator. You can also establish personalized document flows, for example, and manage your folders in the way that best meets the demands of your service.

Auditing is a fundamental process for health plan operators; An efficient sector brings, in addition to financial savings, faster flow of requests and authorizations. In this context, medical audit software can be the best tool to automate processes and optimize their management.

If you are looking for medical audit software, SAUDI could be the solution for you. Covering all the benefits mentioned above, it is a system created especially for supplementary health plan operators. If you want to know more, Contact us. We look forward to meeting you and answering any questions you have about our platform!