How to Mitigate Risk While Auditing for Revenue Integrity: Sample Design, Interpreting Results, & Navigating Compliance Next Steps

This episode examines how healthcare organizations can mitigate compliance and financial risk while conducting revenue integrity audits. PYA Principal Valerie Rock and Manager Kimberly Campbell walk through the auditing and monitoring cycle, with a focus on defensible sampling, documentation, and interpretation of results.

The discussion covers:

Probe audits versus statistically valid random samples Use of data analytics Understanding claims and financial error rates Navigating the Medicare 60-day rule when overpayments are identified Corrective actions Root cause analysis Internal controls needed to support sustainable compliance after an audit