What are the Top 7 Benefits of Medical Billing Audits?

Auditing is essential in any business, regardless of industry. It’s a great tool for ensuring proper revenue cycle management, adhering to regulations and laws, and determining where internal processes can be improved. This is especially true when it comes to doctors, especially when it comes to medical claims.

Medical billing audit are used to improve two aspects of a medical practice’s operations. The claims administrator is the first to be audited. The second is a self-audit of your practice’s operations to identify areas of error and how improving from those errors can make a difference.

Medical billing audit is an organized process that examines and evaluates the effectiveness and reliability of clinical documentation.

Dealing with medical claims can be difficult and costly if not handled properly. Medical claims audits may be required for a variety of reasons, including finding errors in medical billing, determining ways to improve recovery opportunities, and ensuring that a medical practice is following the most recent compliance regulations governing medical claims.

Before we go over the advantages of medical billing audit, let’s go over the different types of audits that are done.

Medical claim audits come in various forms.

Medical billing and claims audits can be conducted regardless of the size of your organization. Regular audits can help keep your medical billing system streamlined and cash flow sufficient.

In medical practice, the following types of audits are carried out:

Audit by Random Sample

In this audit, claims are chosen based on the amount of insurance money available, and both large and small claims are examined. It places a greater emphasis on the dollar amounts than the number of claims involved. A random audit will not result in direct money refunds from insurers, but it will aid in the transition to a comprehensive auditing review.

Comprehensive audit

This audit has a broader scope and examines a group of previously audited clams, both electronically and manually. The comprehensive audit’s ultimate goal is to get you to claim refunds from claims administrators.

Audit hybrid

A hybrid audit combines random sample audits and comprehensive review audits to achieve the outcomes of both factors, such as money recovery and regulatory compliance. It also emphasizes the prompt recovery of overpayments.

 Advantages of medical claims audit

The federal government does not require a self-audit, but it is encouraged by the CMS.

According to CMS, medical claims audits can provide the following benefits to medical practice:

1: Reducing and avoiding erroneous payments

Audits can keep track of your regular and irregular payments and advise you on how to proceed with your claims partner in the future. It assists in determining the cause of claim reimbursement/medical billing system delays and provides a clear picture of improvements and best practices. This will undoubtedly assist you in reducing payment issues and preventing insufficient cash flow in your medical practice.

2: Ensuring that claims are recorded perfectly

Because audits check every nub and cranny of medical billing and claims submission, your future claims will move forward without being rejected by the insurer. When claims are submitted correctly, your revenue increases, which leads to increased patient satisfaction.

3. Enhancing patient care

Regular audits help you get reimbursed faster and focus more on the patients who come to your medical practice. When medical billing and claims processing workflow is simplified, you can run your business more efficiently and devote more time to your patients.

4: Minimizing the risk of an external audit

There is no need to spend time and money allowing external audits if your internal medical audits are sufficient to provide scope for improvement and point out messed-up areas.

5: Real-time feedback on employee performance

Internal medical audits allow you to quickly identify good and bad employee performance and provide immediate feedback on areas where they can improve. It also holds your employees accountable for errors, encouraging them to work more responsibly.

6: Cost-benefit analysis and regulatory compliance

Audits assist your practice in identifying areas where you can withdraw pending or slowed-down funds, as well as introducing new policies and procedures to avoid previous mistakes made by your staff. As a result, audits provide cost and compliance benefits.

7: Strengthening weak areas

Internal audits can help you understand how efficient your staff is at medical billing and claims services, so you can provide them with appropriate training in areas where they struggle.

Advantages of Medical Billing Audit

1. Irrelevant coding or coding errors result in claim denials; medical auditing assists in identifying and correcting problems before insurance or government payers challenge inappropriate coding.
2. Unnecessary billing will have an impact on either healthcare providers or patients. Medical auditing is one of the methods for preventing fraudulent claims and billing.
3. When patients are not charged for all of the treatment or administrations they receive, this is known as under coding. Audits and investigations may be required as a result of these fraudulent activities. Medical auditing facilitates the prevention of such issues and the proper billing of documented procedures.
4. It is the responsibility of medical coders to research and use any new or reorganized codes as they become available. Auditing also aids in the elimination of outdated or incorrect procedure codes and the implementation of a new coding process.
5. Medical auditing identifies outliers before large payers discover them in their claims software and ask for an internal audit.
6. It aids in the identification of reimbursement gaps and opportunities for proper reimbursement.
7. Medical auditing aids in the verification of ICD-10-CM and EHR meaningful use readiness.

Medical Records Auditing

Determine the scope of your audit

The main goal of your audit is to find out which medical practices are inconsistent or need to be improved. The audit process should have some basic characteristics, such as being specific, measurable based on data available in the records, and critical to the efficacy of your hospital and patient care.

Define the evaluation criteria

Determine the specific measurement criteria for the review after you’ve determined the focus of your medical records audit. Finally, decide what factors will determine whether or not these criteria are met.

A literature review can help speed up the process by eliminating the need to develop estimation guidelines by using techniques that have previously been proven to work. Literature reviews can also serve as benchmarks for further investigation.

Choose which documents to examine

Determine the precise patient population to be evaluated first, as this will only help you decide which records to audit. Consider the patient’s clinical status, gender and age, and treatment routine, and make sure everyone involved in the audit is aware of the criteria used to determine whether a patient is included or excluded. This decision is frequently influenced by the audit’s scope and estimation standards.