Effects of DRG audits on provider sentiment and abrasion


Audits cost providers as much as $1 million annually and damage relationships, but there is an upside a new study says. 

Results presented in "Payment Integrity Programs: A National Study on the Impact of DRG Audits on Provider Sentiment and Abrasion", conducted by Change Healthcare and Frost & Sullivan, indicate that some providers are paying upwards of $1 million per year on audit compliance costs and experiencing routine relationship damage with payers.

The data does present an optimistic opportunity: providers report openness and satisfaction with new payer methods that reduce audit costs, and some providers are in good positions for education on new cost-and time-saving methods.

“The message for payers is clear: Those that adopt innovative, provider-friendly techniques-such as pre-submission notifications-and deliver a positive experience in these areas can improve their relationships with providers, while still meeting their audit requirements,” said Dave Cardelle, RPh, Change Healthcare’s vice president of payment integrity in a statement. “You won’t find any disagreement among payers or providers that payment audits are tedious and expensive, but necessary. However, the challenge for payers is also the opportunity-to make something inherently objectionable to providers less intrusive and more cost-effective for both parties.”