Take the headaches out of healthcare audits and chart reviews
HealthMark Group’s medical records audit solution can save your organization time and resources – while reducing your staff’s stress.
Alleviate the administrative burdens from chart audits.
Medical chart audits can be a major burden on your staff. Don’t let audits drain all your time, energy and resources. HealthMark Group’s chart audit solution handles medical records audits of all shapes and sizes. We become a single point of contact for updates and advocate for your organization – not the auditor. We’ve processed over 4 million audits to date, and we’ve never missed a deadline.
Healthcare audit support services
Let our experts be your healthcare audit heroes!
Why should you rely on a third party like HealthMark Group for your healthcare chart audits? Let us count the ways!
1. Quality Control: Our Certified Release of Information Specialists (CRIS) and machine learning quality checks ensure the data requested is the data received by the audit requestors.
2. Compliance: The Minimal Necessary Rule states that auditors should only have access to the portions of the record related to the audit. HealthMark Group follows HIPAA rules to the letter, ensuring your audit requests meet compliance guidelines.
3. Single Point of Contact: We take the burden of communication and status updates off your staff, maintaining a single point of contact with the auditor- and your organization. We contract directly with payers and third parties, freeing up your phone lines for those who need them – your patients.
4. We Don’t Miss Deadlines: We’ve processed over 4 million audits – all of them managed and completed on time. Our qualified team offers objectivity in the review for a smooth and stress-free audit process.
Chart audits we handle
What can HealthMark Group do for you?
At HealthMark Group, we’re here to make life easier for you. When it comes to audits, we take care of the heavy lifting so your team can focus on patient care.
What audits can you outsource to HealthMark Group?
- HEDIS
- RAC
- MRA
- RA
- DRG
- QIO
- And more!
What are records audits in healthcare?
The healthcare audit 411
Chart audits can be overwhelming for healthcare organizations of any size. While audits play an important role in measuring outcomes, compliance and patient satisfaction, they can potentially expose systems or providers to monetary losses or other repercussions.
In healthcare, there are two types of audits: government audits (these are often the most stressful for your staff) and chart reviews or risk assessments. No matter the type, audits often create large administrative burdens – which is where a trusted outsourcing partner (like HealthMark Group!) can help.
Audits in Healthcare Information Management
Commercial Healthcare Audits
Just as government-backed healthcare entities conduct audits of healthcare systems and providers, so do private health insurance companies. Larger companies, such as United Healthcare, Aetna, BlueCross BlueShield and many others will conduct their own audits. When healthcare systems or providers establish a contract with an insurance company, they agree on reimbursement rates, as well as what claims can be audited. Oftentimes, insurance companies will use the auditing process as a way to reexamine or renegotiate the payment schedule agreed upon in the contract.
HEDIS | Chart Reviews & Risk Assessments
The Healthcare Effectiveness Data and Information Set (HEDIS) is administered by the National Committee for Quality Assurance (NCQA) and is one of healthcare’s most widely used quality improvement process tools. HEDIS measures cover six primary care domains: effectiveness, access and availability, patient experience, utilization and risk-adjusted utilization, health plan descriptive information, and measures reported using electronic clinical data systems. Participation in HEDIS is done on a voluntary basis by healthcare organizations and helps to provide a nationwide, standardized framework for healthcare measurement and reporting. HEDIS audits have two parts: a review of an organization’s overall information systems capabilities for collecting, storing, analyzing, and reporting health information, and compliance with conventional reporting practices and HEDIS specifications.
MAC | Medicare Administrative Contractor
Medicare Administrative Contractors (MACs) are private healthcare insurers that have been awarded jurisdiction to regionally process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. The Centers for Medicare and Medicaid Services rely on a network of MACs to act as the primary operational contact for the Medicare FFS program and the providers enrolled in it. MACs handle many administrative tasks surrounding Medicare claims, including claims processing, provider enrollment, education and outreach, provider support and assistance, and Medicare policy interpretation.
RAC | Recovery Audit Contractors
Recovery Audit Contractors (RACs) are implemented by the Center for Medicare & Medicaid Services to help identify and recover improper payments between providers and payers. RACs evaluate Medicare claims and reimbursement, looking for underpayments or overpayments, billing or medical coding errors, non-compliance, and fraudulent activities. RAC is a comprehensive compliance program for Medicare and Medicaid providers.
RADV | Medicare Advantage Risk Adjustment Data Visualization
The Medicare Advantage Risk Adjustment Data Visualization (RADV) program is the Centers for Medicare & Medicaid Services’ primary way to address improper overpayment to Medicare Authorized Organizations (MAO). A RADV audit confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the patient’s medical records. RADV audits are intended to validate the accuracy and completeness of diagnoses by Medicare Advantage.
Why Choose HealthMark Group?
We make audits easy by taking the hard work off of your plate. When you choose HealthMark as your release of information partner, sending audits to us is easy. You just upload the file and we handle the rest!