Medical billing is the process by which healthcare providers submit claims to insurance companies. Because so much goes into this lengthy and laborious process, it is not uncommon for errors to occur along the way. As a result, it is critical to have an auditing process in place to ensure the accuracy of claims. Consider the following four suggestions for medical billing audits.
A medical billing audit examines medical billing records to identify areas that need to be improved or given special attention. Medical billing audits can reveal a variety of issues, including Provider documentation containing errors. Wrong or inappropriate codes, use of deleted codes, and frequency of such errors
Make a Group
Medical organizations can benefit from having a team of motivated individuals in charge of auditing their medical billing processes.
This team’s members would collaborate to collect reports and analyses their findings. They must be competent individuals who are obsessed with obtaining the correct numbers. You should also assign defined responsibilities to everyone on that team. Before beginning, an audit, make sure that everyone on the team understands their roles within the system in place.
A medical organization should constantly seek ways to improve its current operations. Using a thorough auditing system is one of the best ways to streamline your practices. In addition to revealing human errors, a thorough audit should indicate whether your current medical billing system is on track. For example, by analyzing your collections, you can gain a better understanding of your organization’s current performance and then devise an improvement strategy.
Always double-check that your claims are complete
You must ensure that all records are completely complete before anyone in your organization begins an audit. In other words, all documents must be submitted together before they can be reviewed. Items cannot be added to the medical chart at a later time in many cases.
Sometimes your company requires an extra set of eyes. Even if you are confident in your current in-house auditing system, an outside auditing service may be beneficial. They may uncover critical aspects of your business operations that you were previously unaware of.
How to Create an Efficient Medical Billing Audit Process
Healthcare providers must have an auditing process in place to ensure that their claims are accurate. If you want to provide the correct information to insurance companies, you must go through a thorough process to catch any errors before submitting a claim for approval. To avoid revenue cycle delays, this extensive process must be clearly defined and executed. It is critical for medical practices to understand that delays typically result in revenue loss. Continue reading to learn how to create a successful medical billing audit process.
Develop a Strategy
Depending on the size of your practice, you will need to develop a clear auditing strategy for medical billing claims. Consider the number of payers you work with, the number of billers and coders in your organization, and the total number of payers you work with. Someone in your organization should be in charge of conducting these audits and following through on a clear plan with randomly selected claims to see if they were processed correctly.
Determine Potential Risks
It is critical to identify any risky trends in billing reports. This can be accomplished by comparing performance over the course of the year. It is critical to run reports on a regular basis to see how specific codes are reimbursed. You want to make sure that payment terms are followed so that you receive your payments.
Adjust as needed
It is critical to set goals for your practice’s medical billing throughout the year. For example, you may want to reduce the number of denied claims. Another step you should take is to consistently follow up with patients to ensure they pay their rates on time. In some cases, tapping a patient on the shoulder several times may be necessary before they respond. Additionally, members of your staff must be trained to collect all of the information required for your practice to code correctly.
A Checklist for a Medical Billing Audit
A medical billing audit is one way for a healthcare facility to keep track of its quality and compliance. An audit considers all aspects of running a medical practice, most notably the processes that result in reimbursement. All of the steps involved in reimbursement are carefully monitored to ensure that everything is in accordance with local regulations. Consider some of the items that should be included on a medical billing audit checklist.
Verification of Patient Records
Verifying the patient’s authorizations and identification is one of the first steps. Patients’ information, such as the date they visited your facility, the location of service, and their name, must be accurate and consistent with the claim documents.
You must also examine your patient’s insurance coverage plan to determine whether it was valid and in effect on the date the services were rendered.
Verification of Provider Data
You must verify not only the patient’s information but also the information of the provider who performed the services and crested the charges. You should only work with providers who have the necessary licensing and credentials, so double-check to ensure you’re working with a legitimate provider.
Validating Electronic Health Records (EHRs)
Match all of your records’ IDs, confirm whether or not the proper dates have been entered for each visit and procedure that has been provided, ensure that information has been filled out completely, and confirm whether or not previous medical history has been correctly recorded for your medical billing audit checklist.
Smoking, food and drug interactions, substance abuse, allergens, and alcoholism should all be addressed in patient information.
Examining Diagnostic Reports
For any medical billing audit, you must consider your patients’ potential disease conditions and ensure that the diagnostic procedures used are appropriate for testing for these conditions. Radiological results must include image interpretation, and they must be approved by the provider who interpreted the results. Lab results must be completed with all of the necessary authorizations and dates.