How Nurse Auditors play a key role in improving Revenue Integrity?

Do you want Nurse Practitioners to focus on patient care, or to be saddled with non-clinical queries from the revenue cycle business teams?

Access Healthcare celebrates National Nurse Practitioners Week 2019.jpg

While their primary responsibility is clinical care, we cannot undermine the documentation requirements as it drives the revenue integrity – and its nearly impossible for the nurse practitioners to balance both, without proper education to policies and procedures, digital tools, and processes to manage the clinical practice from a business perspective.  

As we celebrate the week of National Nurse Practitioners, so we want to emphasize the importance of Nurse Auditors in improving revenue integrity across the healthcare revenue cycle value chain.  Nurse Auditors are a relatively new role that is gaining momentum these days. Virtual nurse auditors are evolving to support the back-office operations of revenue cycle practice.

Access Healthcare employs nurse auditors to deliver high-quality, complex services such as prior authorization, utilization review, and denial audit. We are investing heavily in developing a COE (Center of Excellence) for prior authorization and utilization review in our Delivery Centers located in Manila, Philippines. The COE is a composition of healthcare professionals with AAPC-certified members and registered nurses, in-house developed automation toolsets, and robust processes powered by our proprietary best practice engine.

The Values that the Nurse Auditors contribute to Revenue Integrity.

  • With the proficiency in the medical documentation and its terminologies, Nurse Auditors effectively address the causes for claim denials and documentation gaps

  • Nurse Auditors, besides working on the documentation review, also support related services such as in-patient coding, charge entry, and care coordination services

  • The role of Nurse Auditors frees Nurse Practitioners from query resolution by allowing them to focus on patient care and care assistance

  • Clearly, this role contributes to the revenue integrity initiatives, and there is a growing need for registered nurses in healthcare offshore locations, especially in the Philippines