Current Accounting and Auditing Issues in the Healthcare Industry

healthcare billing and reimbursement cycleThere are a number of accounting and auditing issues that are plaguing many providers within the healthcare industry. In order to lessen the blow of the new programs and measures being implemented under the Affordable Care Act (ACA), healthcare providers have turned to healthcare consultants to help them iron out the details of some of the new regulatory legislation that has come out. These healthcare consultants are able to help physicians, hospitals, urgent care facilities, and others iron out the details for smoother operation. The following are just some of the matters that the healthcare industry has to address.

Accountable Care Organizations

Many case studies have been done on Accountable Care Organizations (ACOs) and whether or not they will deliver better healthcare. It is said that market innovation will be what truly improves healthcare.

Nonetheless, providers will be exposed to ACOs because these are organizations that provide financial incentives to health care organizations to improve care quality and reduce costs. ACOs are simply the latest in a long history of health policy and it is believed that they will become too large to fail. They are promoted as a way to address the areas where previous reforms lacked. Different participating groups, such as hospitals and physician groups, may be included. To be included, they must have a formal legal structure and a meet a number of requirements. A healthcare consulting firm can be used to help physician groups and hospitals in all matters involving Accountable Care organizations.

As of now, ACOs are what has been established and they are a part of the law of the land, which means having a proper understanding of how they work. It is more or less a collaborative effort between physicians to ensure patients receive the best healthcare while reducing costs for all involved.

Medicare RAC Recoveries and Receivables

The RAC program is controversial, but its purpose is to root out the fraud and waste that exists in the Medicare program.

The fact is that Medicare is one of the largest insurance programs in the U.S. It insures nearly 50 million seniors and other beneficiaries and it is a program that is expected to go bankrupt by 2026. The aging baby boomer population, advances in treatment, and new legislation have all contributed to this.

The RAC program was created to address the $30 billion in improper payments by CMS each year and taxpayers are the ones that pay for these errors. Up until now, a physician would hire a healthcare consulting firm to help them reduce the amount of improper billing at the physician level that could cost the physician. However, CMS created RAC in order to address the issues at a much higher level.

Because of the program, recovery auditors will work directly with medical facilities to acquire medical records and then reimburse hospitals for every record that they request at a per sheet rate and up to $25. The hospital industry claims that they will shoulder undue administrative and financial burdens under the RAC program, but they recognize that taxpayers could be saved billions. Healthcare consultants are valuable assets in auditing matters so that resources can be evenly distributed within the hospital or other healthcare facility instead of on the audit process alone. This allows for effective management even when CMS is requesting records to be pulled and evaluated.

Meaningful Use Certification and Payments

Meaningful Use is the qualification that has to be met in order to receive federal funding for using health information technology, specifically the use of electronic health records. Those healthcare organizations that achieved Meaningful Use by 2011 were eligible for incentive payments. Those that fail to meet the Meaningful Use standard by 2015 may be penalized.

ICD-10 is the perfect example of achieving Meaningful Use. Physicians and facilities need to be ready for this transition by October 1. While there may be a hardship exemption that will have some flexibility, it is important for physicians and facilities to be ready as soon as possible

Effectively Addressing the Challenges

It is very important for physicians and hospitals to address new programs and laws as soon as possible in order to ensure compliance. The earlier work begins on compliance, the least expensive it will be in the long-term. In order to receive the effective guidance while also maximizing manpower within a facility or office, a healthcare consulting firm can oversee operations and provide guidance on successful implementation and compliance. From RAC to ICD-10, matters involving PQRS, and more, there is a lot to keep track of to ensure proper payments through fewer errors.


When it comes to time-consuming accounting and auditing, you do not have to do it all alone. MD Pro Solutions helps processes move smoothly and can provide you with the guidance you need to ensure compliance. To learn more, call us at (508) 946-1665, toll free at (800) 853-8110, or visit our contact page.