How can internal audits enhance RADV audit success?

Internal audits play a crucial role in enhancing the success of RADV audits by identifying and addressing weaknesses in coding practices. This proactive approach allows organizations to review and improve their coding accuracy and compliance with regulatory standards before external audits take place. By highlighting areas where coding errors or inconsistencies exist, internal audits provide the necessary insights that enable healthcare providers to rectify issues, thereby minimizing the risk of audit findings that could result in financial penalties or loss of funding.

An emphasis on addressing weaknesses in coding not only helps to ensure accuracy in patient records but also contributes to a more favorable outcome during RADV audits. This is because well-validated data will lead to higher confidence in the results of the audit process and better overall management of risk adjustment data.

While increasing the number of claims, reducing the audit period, or avoiding external audits might seem beneficial, these approaches do not specifically enhance the quality or accuracy of the data being reported or improve compliance. In contrast, focusing on coding integrity through internal audits directly impacts the quality of the information essential for RADV audits.