Medical billing audits should be conducted on a regular basis to determine a practice’s level of effectiveness and efficiency when it comes to claims. Even with the forced transition to ICD-10 CODING in the past, the importance of billing audits has not diminished in the healthcare industry.
When there are no sudden/frequent spikes in denials and you are satisfied with your practice’s reimbursements, you may believe that your medical billing processes are just fine. In this highly competitive business environment, keeping hold of earned dollars is far more important than simply earning for practices, large or small.
What is a Medical Billing Audit, Exactly?
A medical billing audit is an organized process that examines and evaluates the effectiveness and reliability of clinical documentation, according to one source. This process thoroughly examines all of the practice’s health records, as well as medical billing data submitted to payers, to ensure that the practice detects, monitors, and corrects any improper billing practices.
Because billing has an impact on the bottom line, highlighting potential compliance issues is critical.
During a medical billing audit, clinical records such as lab reports and medical records, as well as financial records such as remittance advice, charge sheets, policy-related documents, and so on, may be requested by the providers or the government.
Benefits of Medical Billing Audit
It is beneficial to your practice in every way if you do it on a regular basis. Let’s take a look at the advantages in terms of points for a better understanding.
- A medical billing audit can help your practice become more profitable.
- A billing audit of medical record documentation can uncover unnecessary or unrecorded charges for services or items provided to a patient.
- The process of coding staff by allowing them to identify, understand, and correct issues before they are flagged by the government or an insurance payer for incorrect coding.
- Doing this can help your practice to improve your medical record documentation that in turn increases the payments for the services provided. This results in the first benefit.
- This will assist your practice in improving its medical record documentation, which will result in higher payments for the services provided. The first benefit is as a result of this.
- These audits establish a standard for the administrative staff to follow, reducing stress and frustration.
- A medical billing audit can provide your practice with protection against fraudulent claims and compliance issues.
- This is especially important when providing Medicare services.
- Medical auditing aids in the verification of ICD-10-CM and EHR meaningful use readiness.
What Does It Mean for Your Practice?
A medical billing audit is essential for your healthcare practice because it identifies areas where you can improve as a service provider.
It helps in the accurate and timely documentation of medical records.
“It’s Not Always About the Type, But Who’s Conducting” Internal vs. External Billing Audits.
Because they may not have a specific group of people assigned for this purpose, a small practice will have a specific time set aside for this purpose.
Larger organizations, on the other hand, may have a dedicated group of people who conduct audits on a regular basis. Auditing on a regular basis leads to continuous improvement in their processes.
An external audit, on the other hand, is beneficial and best suited for smaller healthcare organizations. It raises awareness, which reduces disputes and aids in the detection of upcoding, which even experienced internal auditors may overlook.
External audits, on the other hand, are not a suitable substitute for internal audits. Larger organizations that conduct internal audits frequently can benefit from an annual independent external audit.
Now That You Know the Details of a Billing Audit
Evaluate: Review your billing reports to identify the high-risk areas. To find inequalities, compare it to your previous performance.
Make changes after you’ve gathered all of the necessary information. Make a plan to improve and set a goal for yourself.
Next what? Changing plans and executing for future betterments and improvements in the last step of the process. But it cannot end there. You need to do the process again and again. Remember, frequent medical billing audits help your organization’s chance of increasing profitability.
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