As a result of the following developments, increased scrutiny of health information is driving the need for sharable data.
- More covered lives
- Accountable care organization growth
- Health information exchanges
- Healthcare reform
- Value-based payment
- Legal developments
- Billing advancements/quality compliance/audits
Audits are on the rise and include the following audit types.
- Commercial plan audits
- Health Effectiveness Data and Information Set (HEDIS)
- Medicare risk adjustment
- Commercial risk adjustment
- Government audits
- Medicare Administrative Contractor (MAC) program
- Recovery Audit Contractor (RAC) program
- Comprehensive Error Rate Testing (CERT) program
- Office of Inspector General (OIG)
- Quality Improvement Organizations (QIO) program
See related article: Using Audits to Improve Compliance, Cut Future Audit Risk
Source: CIOX Health. Used with permission.