Medical audit analyzes healthcare organization’s processes and outcomes. Healthcare professionals must have an auditing process to ensure that their claims are accurate. Medical audit focuses on precision, dependability, and efficiency of a healthcare organization’s record. Multiple strategies should be adopted for auditing medical billing. These strategies include internal healthcare billing audit or request for an external billing audit.
Internal audits are performed by the dedicated specialists who conduct audits regularly to ensure transparent and effective billing practices. Internal audits are the best solution for medium and large-sized healthcare organizations that can keep auditing experts on staff.
External audits necessitate collaboration between healthcare organizations and an external auditing body. It maintains billing practices standards to identify and correct any issues. External audits are more appropriate for small practices that lack the necessary specialists on staff.
Importance of Medical Billing Audit
A billing audit is a comprehensive procedure covering all medical billing cycle processes, including patient eligibility verification, patient demographic data capture, medical coding, claims submission, payment posting, accounts receivable, and denial management practices. A medical billing audit examines records to determine coding accuracy, policies, and procedures.
Medical billing audits can expose a variety of issues, including:
- Documentation mistakes
- Incorrect codes and use of deleted codes.
- Payer reimbursement issues.
- Non-compliance with payer rules.
- Errors in medical practice’s claim scrubber software.
Successful Medical Billing Audit Process
Determine the scope
Examine your documents and the upcoming medical billing audit scope to determine the resources required. The number of providers, payers, billers, and coders must be estimated. It will help you in recognizing that why an auditing team is necessary for regular and thorough checks.
Assemble External and Internal Experts for a Medical Billing Audit
You will certainly need to incorporate internal and external audits. Find a suitable independent auditor and comply with how to demand a medical billing audit before you begin. Independent auditors are third-party experts trained to conduct medical billing audits. They have professional experience and always remain objective in evaluating billing processes accurately. According to the American Association of Medical Audit Specialists auditors and audit coordinators must be competent in the following areas.
- Health record format and other forms of clinical documentation.
- ICD-10-CM, HCPCS, CPT, and medical terminology.
- Fundamentals and standards of auditing.
- Billing processes and billing claim forms (UB-04, HCFA 1500)
- Regulations governing patient records at the federal and state levels.
Develop an audit strategy
When you’ve determined the scope and assembled a team, it’s time to choose the best strategy. We recommend selecting a set number of records at random for each provider and payer to clarify things. You can then review the paperwork for the selected documents to identify any inconsistencies or inaccuracies.
Recognize or contest the audit report
You must resolve every problem revealed by the audit as soon as possible. If you, as a provider, disagree with the research results of an audit, you have 60 days to contest them.
These steps comprise a standard healthcare billing audit procedure that you can use for medical billing auditing. Because healthcare checks must be performed regularly, an action plan is recommended. You can also use the medical billing audit checklist provided below to ensure that all required aspects are checked.
A Checklist For Medical Billing Audits
It is beneficial to use a checklist during a medical billing audit. It will help you stay on track and prevent losing something.
- Verification of patient records and containing the essential biographical information.
- Verification of providers’ information.
- Each chart includes the name of the caregiver.
- All EHR, billing, and other healthcare management system entries are dated and legible.
- Audited patient records contain an accurate medical history.
- Audited patient records contain critical information (e.g., allergies, adverse drug reactions, alcohol, smoking, or substance abuse)
- Laboratory tests are ordered and dated correctly.
- Verification of diagnostic reports.
- Proper documentation on prescribed medications.
- Collaboration between primary care and specialty care physicians.
- Verification of assigned codes.
- Medical codes are correctly designated and formatted.
- There are medical codes for ancillary services.
- Billing and expert documents use templates.
How A Medical Billing Audit Can Help Your Practice?
Conducting regular medical billing audits are used to identify problems costing you money and helps you to run an efficient practice. Medical billing audits can help you discover ways to increase profits and avoid costly penalties for Medicare reporting errors. A medical billing audit can also secure your medical practice from false allegations and issues with compliance. A medical billing audit on medical record documentation can reveal items that were not recorded in the form of charges provided to a patient. Improving medical record documentation can result in higher payments for services offered and makes your practice more profitable.
Benefits of Quality Medical Billing Audits
Following are the benefits of quality medical billing audits.
- Enhances coding accuracy under the most recent guidelines.
- Classification of harmful errors.
- Improved billing system dependability and transparency
- Streamlined workflow of your medical practice’s
Improved collaboration between medical practices and insurance companies
Prevent Penalties For Your Medical Practice
Medical billing auditing may assist protect your practice against fraudulent billing and claim submission, which saves you from significant penalties. A government strike is possible if your medical billing and coding services are not HIPAA compliant. They have the authority to penalize your medical practice if your billing benchmarks are not up to standard. Thus, billing audits are critical for improving medical billing and coding standards and streamlining the financial situation.
Best way to identify irregularities is to review clinical notes thoroughly for accuracy, and coding compliance. Working with a professional medical billing outsourcing company ensures a strategic approach to revenue cycle management, billing and coding audits. To select the best medical billing company, consider their experience whether they provide competitive prices or not. We have the proper tools and specialist auditors to identify potential risks. We can help you remove all drawbacks in practice by utilizing innovative software and expert auditors.
Our medical billing team streamlines the entire billing process. We improve clinical and service expansion by optimizing your charges, submit your claims, collect on time, reduce accounts receivables, identify underpayments, and increase your practice’s net collection.