How does our integral audit model work?
At RGC, we’ve perfected the auditing process, allowing us to adapt to various health care service models in addition to meeting the requirements of each insurance provider. By combining our industry expertise with ACTIVA, we can apply tactics that address clients and business challenges by adding value through innovative solutions.
Solutions that generate changes in your company
We are knowledge managers because we advanced from a traditional transactional audit to a risk-oriented one. We execute the audit as a protective factor of rights of each key player in the health care system, promoting justice and quality in each of the processes that we run.
- Concurrent or site audit
- Retrospective or documentary
- Quality and regulatory fulfillment
- Entry and exit processes of physical or digital documents
- Audit Operability and Data Mining
- Planning for the execution of health services audit
- Analysis of the model based on results
We execute this audit when the insurer requires that all services associated with patient care are validated in person, or to enhance the quality of the service provider.
Through the Concurrent Audit you can:
Monitor the quality of the services provided according to the agreement.
Analyze time-sensitive care features.
Follow up on treatments and improve user satisfaction.
Have direct contact with patients and identify the perception of the service.
Monitor the provider’s condition to measure the risk of an unexpected event.
This audit is compiled using all data and systematically evaluates the quality, relevance, technical-scientific rationality, and accessibility, while being supported by an expert team.
Through the Retrospective Audit you can:
Make payments for services using data that determines their value or relevance.
Verify rates with providers to ensure an automated payment summary.
Build mutually beneficial relationships between insurance companies and health care providers.
Rationalize and optimize the recruitment.
Designed to analyze the quality of service provisions from the user’s perspective and the standards set by the Mandatory Quality Assurance System (MQAS), which in turn, minimizes costs for non-compliance contracts.
Through Quality Audit you can:
Measure the efficiency of processes related to the care and satisfaction of users to provide key data for decision-making.
Evaluate the management of services offered by the IPS with in-person quality inspections of the health care institution.
Request improvement plans if an institution fails to meet quality standards.
Digital Document Management
Our ACTIVA software offers digital asset management to support our paperless strategy, which optimizes the archiving process and empowers our users to manage documents in a way that’s automated.
Through Digital Document Management you can:
Integrate files generated by Electronic billing in accordance with our guidelines.
Minimize time spent managing accounts by offering self-management to suppliers.
Upload invoices, supporting documents and RIPS online with real-time notifications on medical-billing entries.
Verifies and ensures accurate data entry for audits and payment of services, reducing processing times.
Enable the homologation of varying invoices from the same supplier.
We conveniently receive and process all documents attached to the collections delivered by the health care provider.
With File Management you can:
Minimize how case files are handled to preserve document integrity.
Utilize our help desk to classify documents, prioritize transactions and prepare files for digitalization.
Identify original documents and control the image quality of illegible documents.
Avoid fraud resulting from manual document filing.
Deliver documents to meet your client’s requirements.
Deliver and close cases in the processing times required by the client.
ACTIVA Technology Platform
ACTIVA is our empowering technology platform that integrates systems, allowing you to manage controls in real-time and guarantee secure access to data – which in turn, prevents fraud and minimizes filing mistakes.
Through ACTIVA you can:
Receive digital or physical invoices through image sharing.
Enable automatic nonconformities by validation meshes created using the audit.
Monitor vendor contracts and their requirements in a timely manner to complete the authorization of payments.
Design a self-management model using streamlined data, delivering reassurance between parties, and thus, making the process more efficient and maximizing the use of resources.
We analyze the factors that affect health risk management, which is designed to optimally use resources. Our method estimates the efficiency of the model, then suggests ways to improve and guides those efforts so you provide a more efficient and profitable delivery. Rely on our qualified team of medical professionals and in our software, specializing in every aspect of health care management.
With Consulting you can:
Get help with the planning, transition, adaptation, and awareness of changes.
Enact and manage processes with faster turnaround times.
Minimize risks to ensure the stability and accuracy of the operation.
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