It is up to you how in-depth you want to go with an internal medical billing audit, but a more thorough approach will usually provide better outcomes. There is no one-size-fits-all checklist because every medical practice is different. Still, there are specific fundamental actions that every office should follow and crucial concerns along the way while preparing for a medical billing audit.
Determine The Audit Scope:
Several possibilities include a random audit, a complete audit, and a hybrid audit. In a random audit, large and small claims are picked randomly depending on their financial values. A comprehensive audit includes a detailed examination of audited claims, emphasizing claiming refunds. The hybrid audit combines random and thorough audit methodologies by assessing samples of all sorts of claims to identify any gaps. When determining the scope of the audit and the number of shares to evaluate, you must also verify that you have the necessary resources and assistance to perform the process correctly.
Plan the Scope and Process
- Determine the extent of your medical billing audit and the resources required to carry it out. Analyze how many providers you have in your practice, how many payers you interact with regularly, and how many billers and coders you have in the team.
- Assign a team member or employ an outside expert to perform the evaluation.
- Plan your medical billing audit strategies. The tried-and-true method randomly chooses a specific number of charts per provider and payer and verifies documentation to what was filled. You also may determine if interactions were under coded or over coded and whether claims were handled correctly.
- Create and circulate a formal audit plan.
Examine the Situation
- Examine your billing records for any concerning patterns or high-risk locations. To identify abnormalities, compare them to previous month-to-month and year-to-year performance.
- Examine the frequency of your physician services during a specific period and compare it to the frequency of your competitors using the most recent industry benchmark data.
Make Alterations
- Based on the above-mentioned statistics, set a goal for improvement, such as lowering the number of refused claims or boosting revenue per patient.
- Make a determined effort to encourage payers to pay their agreed-upon rates timely and accurately. Follow up as much as required and develop a strategy for dealing with late payers.
- Address any internal issues, and train your employees on how to grow in areas where they are weak.
Repetition
- Auditing should be done regularly. If you perform your medical billing, it’s good to do an internal medical billing audit at least once a year. Large practices may have them as frequently as once per quarter.
- Create processes in your medical billing business to facilitate audits. Run regular reports and pay attention to net collections.
