Medical Billing Audit is an organized process that examines and evaluates the effectiveness and reliability of clinical documentation. This process thoroughly checks all health records maintained by the practice and reviews medical billing data submitted to the payers to ensure that the practice identifies, monitors, and rectifies inappropriate billing practices. As aspects of billing affect the bottom line, so highlighting potential compliance issues is essential.
How a Medical Billing Audit Can Help Your Practice
Regardless of the reason, conducting routine medical billing audits is advantageous for your practice. By doing this, you can make your practice more profitable. Billing audits can be used to identify inefficiencies that are costing you money even though they are initially compliance checks to ensure that your operation is efficient and compliant.
One way to find services or items provided to a patient but not recorded as charges is to conduct a medical billing audit on the medical record documentation. Alternately, it’s possible that your management services necessitate a higher level of CPT code for the visit or the frequent use of incorrect codes, as revealed by your coding and billing audit.
Increased payments for the services rendered as a result of better medical record documentation can increase your practice’s potential for profit.
A medical billing audit can also safeguard your medical practice from erroneous claims and regulatory problems. This is becoming more crucial if you offer services under Medicare. Accurate submittals are necessary for Medicare payments. Medical billing audits can help you not only increase revenue but also avoid hefty fines for Medicare reporting errors.
How to Conduct a Successful Medical Billing Audit in 4 Easy Steps
You can choose how in-depth you want to make your internal medical billing audit, but going further will inevitably result in better (and more useful) results. This is particularly true if you haven’t recently reviewed or reevaluated your billing policies and procedures. There is no universal checklist because every medical practice is unique, but there are some general steps every office should follow and important things to keep in mind as they prepare a medical billing avcılar escort audit.
1: Describe the Process and Scope
Establish the size and staffing requirements for your medical billing audit. At this point, you might want to take a look at your practice’s provider count, the number of payers you typically work with, and the number of billers and coders you have on staff.
Select a team member or work with a third party consultant to carry out the review.
Plan out your audit strategy for medical billing. The tried-and-true method is to choose a certain number of charts at random for each payer and provider, and then compare the documentation to what was actually filled out. From there, you can evaluate whether encounters were properly coded or incorrectly coded, as well as how well claims were handled. Create and distribute a formal audit plan.
2: Assess the scene
Look over your billing reports for any alarming patterns or risky areas. To find discrepancies, compare them to prior performances on a monthly and annual basis.
Examine your physician’s visit frequency over a predetermined time period and contrast it with that of your peers using the most recent industry benchmark data. You can also run an E&M frequency report through your billing programme and compare the results to the most recent Medicare E&M frequency information from your medicare carrier.
3: Make Changes
Make a concerted effort to convince payers to pay their contracted rates promptly and correctly. Develop a strategy for dealing with late payers and conduct as much necessary follow-up. In order to improve in areas of weakness, train your staff and providers and address any internal issues.
4: Continue
Make auditing an ongoing process. Large practices may carry them out as frequently as once every three months.
Create processes for your medical billing business to facilitate auditing. Monitor net collections and run frequent reports.
Checklist for Medical Billing Audits
Here is a checklist to manage all the above steps in your medical billing audit to help you stay organized:
1:
- Ascertain the size and number of people required to carry out your medical billing audit.
- Select a team member or work with a third party consultant to carry out the review.
- Plan out your medical billing audit strategies, such as choosing a specific number of charts for each payer and provider and comparing the documentation to what was actually filled out.
- Create and distribute an official audit plan.
2:
- Examine your billing reports for alarming patterns or potential problem areas, making sure to look for any discrepancies by comparing them to previous results.
- Over a predetermined time period, contrast the frequency of your doctor’s services with those of your peers. You might do this by executing E&M frequency reports.
- Run a report outlining the reimbursement process for your CPT codes.
3:
- Set improvement goals once you have the aforementioned information.
- Engage in a concerted effort to persuade payers to pay their contracted rates accurately and on time
- As soon as you find any issues internally, fix them. For your staff and service providers, this may entail providing more training.
- Set up an auditing schedule for your medical practice.
- Create procedures in your medical billing operation to facilitate auditing, such as regularly running reports and keeping track of net collections.
Is Your Medical Practice Prepared for a Billing Audit from Outside?
Preparing for an External Audit
Medical billing audits are anticipated to occur at an ever-increasing rate in the upcoming years as healthcare continues to advance with an eye toward value in care and fairness in payments. Every aspect of a medical practice’s operations, including end-to-end billing, compliance, and coding accuracy, should be expected to be scrutinized.
Is your business ready in case a medical billing audit occurs? Do you know what aspects of your business could get you into trouble if an unforeseen audit were to happen? This is perhaps even more crucial.
The efforts of the Centers for Medicare & Medical Services (CMS) and regulators are becoming ever more sophisticated, drilling down to the specific codes and modifiers that can be indicative of inappropriate activity, thanks to the continuously expanding volume of administrative data at their disposal.
The creation of a risk-based audit plan
Looking at your data holistically, identifying any problem areas, and then self-auditing only the doctors or charts with the highest risk exposure is a very effective strategy.
If you’re working with a reputable medical billing company, you have access to your administrative data in the same way that government agencies do, in case those agencies decide to audit you in the future if their algorithms detect any irregularities in your billing results.
Defending Your Medical Practice against Payer Inspections
Even though everyone in your practice enjoys surprises, one surprise—a payer audit—is unpleasant.
Payer audits are frightening because so few medical practitioners and practice managers are familiar with their history. Some practices over-correct to prevent problems because they only have a basic understanding of the trigger factors, such as excessive high-level coding or improper or excessive use of modifiers. But those medical practices frequently end up undercharging for encounters on purpose to avoid attracting the attention of unwelcome payers.
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