Article Recap
In a follow-up discussion on the implications of the federal court decision vacating CMS’s 2023 RADV final rule, Gina Stewart, MBA, BSN, RN, CCS, CCDS, Vice President of Coding Quality and Education at e4health, shares practical guidance for HIM leaders facing increased audit scrutiny.
Stewart emphasizes that audit readiness does not require large teams or expansive programs. Instead, she outlines how focused, consistent pre-bill audits—targeting high-risk diagnoses and rotating priorities based on denial trends—can significantly reduce compliance risk and protect revenue. She also highlights the importance of using denial and query data together to identify upstream documentation issues before they escalate into payer rejections.
Throughout the discussion, Stewart underscores the value of cross-functional collaboration between coding, CDI, and utilization review teams, as well as the need to present audit metrics to executive leadership in a clear, outcome-driven way. By framing audit readiness as a proactive revenue protection strategy, HIM leaders can demonstrate measurable ROI while strengthening documentation integrity across the organization.
To read the full 'Revenue Cycle Advisor' article, click here .