What to Expect in Due Diligence Audits & How to Find the Right Auditing Vendor

What to Expect in Due Diligence Audits & How to Find the Right Auditing Vendor

The healthcare industry sees hundreds of facility acquisitions and mergers every year (PwC, 2020). A critical part of mergers and acquisitions is the due diligence process. This general process provides a complete financial and performance picture of a healthcare organization to ensure it is a sound investment. The overall due diligence audit reviews every aspect of the facility, including the physicians, coding, property, finances, and more. In addition, M&A due diligence audits highlight potential liabilities and coding quality issues. At YES, our role in the due diligence process is to review the organization’s coding quality and accuracy.

But, why is a due diligence report necessary? Before a merger or acquisition takes place, most contractual agreements require a due diligence coding and billing quality audit. This is to possibly identify any significant red flags within the organization that is to be acquired. The process also ensures there are no compliance issues or cases of fraud.

What Do Auditors Evaluate in a Due Diligence Audit?

Our M&A due diligence auditing process reviews the healthcare organization’s coding quality and accuracy rates, specifically examining the assigned codes for diagnoses, CPT, modifiers, E/M, and surgeries. Auditors review the organization’s billing practices, claims, and reimbursements.

Here are the steps that YES HIM Consulting takes during due diligence audits:

  1. Acquire the data from the client, either electronically or hard copies on paper. Data includes coded patient records, billing claims forms, and internal policies.
  2. Perform the audit, and confer with the client on any major questions.
  3. Submit a draft review that provides a performance score for coders and recommendations for code changes.
  4. The auditor generates final reports and hand them over to the client’s attorney. The auditor observes attorney-client privilege, so they don’t disclose information to either party.

The Qualities to Look for in a Reliable Audit Vendor

When searching for an independent audit vendor, healthcare organizations should look for several qualities that speak to that vendor’s skills and knowledge in the field. Due diligence audits should only be performed by companies that have experience with these types of reviews and employ experts in coding and auditing.

The vendor should have added processes in place to address security concerns and to keep the findings safe and secure. Thorough data reports should clearly label the findings from the audit and be customizable according to the client’s requests.

YES is more than the average audit vendor. Our team goes out of its way to be a partner throughout the entire process. YES is available to provide guidance and support during every step of the due diligence review. This includes instructions on how to pull organization data for those who have no experience with previous audits. Our auditing experts have performed every type of audit, so they’re qualified to analyze the data and deliver actionable results in a format specified by the client. YES’ coding specialists are proficient in every type of specialty.

Our robust audit reports provide an executive summary of the findings, a dashboard with all the coding accuracy rates, and details and trends that contribute to these results. Offering a quick turnaround on due diligence audits is one of our highest priorities, as we understand merger and acquisition deals move fast.

Don’t risk conducting a due diligence audit on your own or with a vendor with less than 20+ years’ experience in the HIM industry. YES HIM Consulting is fully equipped to perform a quick, thorough due diligence review for your organization. Contact our team today for the peace of mind in your potential financial investment.

Vanessa Youmans

Vanessa Youmans, MA, CCS, CPC – Vice President, Coding Services & ProFee
due diligence

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