Best Senior Living Homecare Agencies | AspectN
                     AUDIT 
ARISSSKOSCIATED WITH  
HOME 
HEALTHCARE  
AGENCIES
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According to the Office of Inspector General (OIG) Findings Report, 90% of the  
Comprehensive Error Rate Testing (CERT) audit denials of high-risk home health 
agencies  were based on “insufficient documentation.” With the Affordable Care Act 
induced additional  provisions, Home Healthcare Agencies have become a target of 
frequent audits.
Types of Audits that Home Healthcare Agencies go through
Home Healthcare Agency has to go through various audits. Being proper documentation 
or  patient health, agencies need to be prim and proper. Some of these audits are;
Risk Adjustment and Medical Record Reviews (MRRs)
Health plan payers or insurance agencies conduct this audit to validate the claims 
made by  patients to rule out any fraudulent claims.
Health Effectiveness Data & Information Set (HEDIS) Reviews
A review is conducted by the Payer or Health Plan agency to check the quality of 
treatment  and care their patient is getting. It ensures that the Home Healthcare 
Agencies effectively  perform the core tasks.
Diagnosis-Related Group (DRG) Payment Integrity Reviews
Diagnosis-Related Group (DRG) classifies different hospital cases to various codes. 
These  codes are verified to validate the claims made by patients.
Care and Quality Improvement (CQI)  Audits
Patients sometimes don’t realize the severity of the disease and might need 
preventive  attention to avoid hospitalization. Healthcare agencies and Health plan 
providers  collaborate to check these cases to reduce medical costs and enhance 
patient safety
.
Five-Star Program (Medicare Advantage)
A quality care audit wherein Healthcare Agencies are rated according to the 
service  provided and client care.
Reason for Home Healthcare Audit to be 
institutionalized
A medical audit has importance for both home healthcare agencies and healthcare 
plan  providers. Audit keeps a check on overpricing and care provided to patients. 
Audits like  Care and Quality Improvement (CQI) Audit and Five Star Program help 
improve the  services provided to patients.
Preparedness needed in these Audits
According to the transcript of an Audio from the Office of Inspector General (OIG) of 
the  United States Department of Health and Human Services (HHS), “Good 
documentation  promotes patient safety and quality of care. Complete and 
accurate medical  recordkeeping can help ensure that your patients get the right 
care at the right time.”
Proper Documentation
Proper documentation involves proper handling and maintaining data. Keeping 
patient  data safe and updated is the key. With data recording shifting to digital 
mode and  solution software coming into the picture, the error rate comes down to 
zero.
Error Correction from the previous audit
Rectification of error is the key in any business. An audit helps in finding out the errors.  
With proper management and remedial measures, error-proofing can be done 
reducing  the scope of any discrepancy in the next audit.
Updated Documentation
Maintaining patient data correctly and keeping it updated is the key. A Home 
Healthcare  Agency needs to constantly edit patient data and add new data to 
avoid missing out on  any patient and keep the data updated.
Challenges faced by Home Healthcare Agencies in Paper-based manual data entry
With the growing digital world, paper-based home healthcare agencies face a lot 
of  limitations.
Repetitive Tasks
With the paper-based model, planning is challenging. The conflicting job roles of a 
Home  Healthcare Agency employee may increase the repetition of work. Same data 
recorded  twice or more times may have an impact on cost, but it also takes a toll on 
the mental  health of the employees.
Scope of Error
Manual entry attracts personal bias and judgment. These judgments may sometimes 
lead  to errors in data entry. With machine-based recording, these errors come down to 
zero.
Software designed for this purpose provides better and more accurate data recording.
High Cost
Be it minor expenditure of stationery or major costs of error in recording, a paper-
based  model attracts huge costs. This includes not just direct cost, but indirect cost 
as well  through an error in reporting leading to audit failure. This takes a toll on the 
intangible  asset of goodwill earned throughout the business.
Nurse Burnout
Being engaged in monotonous and repetitive tasking, nurses might not be able to give 
full  attention to the patients. With the increased workload of data recording, nurse 
dropout  and burnout rates tend to increase over time.
Quality Healthcare Delivery
The core task of any healthcare agency is to provide quality care to patients. With 
the  employees’ fixated on no productive tasks, it may impact employee 
performance and  might have an impact on audit reports checking the quality of 
Home Healthcare Agency  services (Five-Star Program).
Impact of Audit Failure on a Home Healthcare 
Agency
Negative impact on Goodwill
An audit is a  check to verify the reliability of something. With audit failure, customers 
tend  to doubt the agency and might even change their preferred healthcare agency. 
Goodwill  of the agency accumulated over years of service vanishes soon.
Customer Loss
Healthcare runs based on trust. With audit failure, customers tend to lose trust in 
the  organization and may not feel safe. A sense of being cheated might disturb 
them and  persuade them to change their desired healthcare agency.
Heavy penalty
With non-compliance and audit failure, a heavy penalty is levied on the agency. 
This  increases the overall cost that the agency might suffer apart from client 
loss.
Conclusio
n
Home Healthcare Agencies need to operate with care and comply with all 
regulatory  guidelines. Keeping track of these guidelines is a cumbersome as well as 
an exhaustive  task. Shifting to technology-driven solutions is the best option.
Based on a Clinical Protocol Approach, Aspect N helps Home Healthcare Providers 
monitor  Clinical Adherence, Reduce the probability of manual errors, and streamline 
workflows to  enable better productivity and compliance with regulatory norms.
AspectN is a transformation partner and a leading provider of customized, cloud-
based,  and innovative platforms and software solutions. We can partner with you in 
your journey  of facilitating top-notch home healthcare services to those in need. 
While you hone your  focus and success story in the field, we will create a strong 
tech-driven, secure, and  scalable solution in the background that will help you evolve 
and grow ahead of your  competition.