Medical Billing Audit: All You Need To Know

Regular medical billing audits are required for a practice to determine its 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 sector.

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, retaining earned dollars is far more important than simply earning for practices, large or small.

So, let’s get some specifics on the topic and its related points.

What is a Medical Billing Audit?

According to one source, Medical Billing Audit is a systematic process that examines and evaluates the effectiveness and dependability of clinical documentation. This process thoroughly checks all health records maintained by the practice and reviews medical billing data submitted to payers to ensure that the practice identifies, monitors, and corrects inappropriate billing practices.

Because billing affects the bottom line, identifying potential compliance issues is critical.

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, as required by providers or the government, may be requested to be submitted during a medical billing audit.

Advantages of Medical Billing Audit

A medical billing audit does not always have a specific reason or motivation. It is beneficial to your practice in every way if you do it on a regular basis. Let’s break down the benefits into points for a better understanding.

  • A medical billing audit can help your practice become more profitable.
  • A billing audit on medical record documentation can reveal unnecessary or unrecorded charges for services or items provided to a patient.
  • The process assists coding staff by providing methods to identify, comprehend, and correct problems before they are identified by the government or the insurance payer as inappropriate coding.
  • This can help your practice improve its medical record documentation, which can lead to higher payments for services rendered.
  • These audits establish a standard for the administrative staff to follow, allowing them to avoid stress and frustration.
  • A medical billing audit can protect your practice from fraudulent claims and compliance issues.
  • This is especially important when providing services through Medicare.
  • Aside from assisting your practice in increasing profits, a medical billing audit can also assist you in avoiding costly Medicare reporting errors.
  • Medical auditing aids in the verification of ICD-10-CM and EHR meaningful use readiness.
  • A medical billing audit is critical for your healthcare practice because it identifies areas where you as a service provider can improve.
  • It aids in the creation of accurate and efficient medical records.

Internal Billing Audits vs. External Billing Audits: “It’s Not Always About the Type, But Who’s Conducting”

A small practice will have a specific time set aside for this purpose because they may not have a specific group of people assigned to this task.

However, in larger organizations, there may be a dedicated group of people who perform audits on a regular basis. Frequent auditing results in continuous process improvement. This is more advantageous for larger organizations.

An external audit, on the other hand, is beneficial and best suited for smaller healthcare organizations. It raises awareness, which helps to avoid disputes and detects upcoding, which even professional internal auditors may overlook.

External audits, on the other hand, are not a suitable substitute for internal audits. An annual independent external audit also benefits larger organizations that frequently conduct internal audits.

Upgrade System for Professional Billing Audits

We cannot overstate the importance of risk analysis of the billing and coding process in generating revenue. Auditing benefits healthcare organizations’ performance by providing administrative benefits, coding efficiency, a higher claim acceptance rate, and clinical benefits.

Furthermore, improvements in medical billing services do not only increase revenue generation. It also improves quality and transparency in the following ways:

  • The claim compilation and submission process become smooth and instant with improved billing and coding practices.
  • The cost-efficiency improves because there is no need to invest effort and time in processing claims repeatedly.
  • The upgraded system is more dependable in terms of generating timely reimbursements, so the workflow becomes more consistent.
  • Data management and documentation are simplified.
  • We are capable of developing data-driven medical billing and coding strategies.
  • A solid system enables a proactive rather than reactive approach to medical billing and coding services (when some problem occurs).
  • The analysis report aids in strategic decision-making and the improvement of the medical billing and coding process.
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