When reimbursements are on track and denials are not on the rise, it would be a happy moment for practices. They would feel that there is nothing wrong with their billing operations. However, they should rethink if there is something that they might be missing. There a razor-sharp competition in the business environment. Moreover, margins of profit are razor-thin. Therefore, it is essential that practices much collect every single dollar they have earned. This is where medical billing audit becomes critical.
If a practice neglects periodic billing audits, it must not be operating at its peak performance level. They would be losing a lot of revenue, undermining the medical practice’s long-term viability.
What’s Medical Billing Audit
It is a systematized procedure to examine and review documents for accuracy. Through this process, you investigate the effectiveness and reliability of the practice’s detailed documentation. It includes comprehensively checking billing data and health records that payers submit.
Through the process of medical billing audit, you can find, observe, and correct inappropriate, incomplete, or inaccurate billing practices. With the help of audits, you can highlight potential compliance problems that can affect the bottom lines. By conducting such audits, practices can avoid Medicare penalties.
How Billing Audits are Beneficial for Practices?
Conducting billing audits regularly is advantageous for practices. With regular auditing, practices will see a profitability increase. Initially, these audits are compliance measures to ensure that your operations are compliant and efficient. However, it also helps in finding incompetence that is costing money.
For example, practices can identify any uncharged items or services by conducting an audit on the healthcare record documentation. Or, maybe billing and coding audits identify that management services deserve a higher CPT code level for the repeated incorrect codes use or the visit.
Improvement in the record of medical documentation can ensure increased payments against the services you provide. Therefore, practices have an exceptional profit potential by improving their medical documentation through the medical billing audit.
Moreover, auditing medical billing also helps protect a practice against compliance issues and fraudulent claims. This is especially critical when you are offering Medicare-based services. Medicare payments depend on precise submittals. When practice doesn’t document and submit quality measures accurately, they will land penalties. As a result, they will lose practice money.
On one hand, these audits are helpful in finding ways for increasing profits. On the other hand, it also helps evade costly fees for Medicare reporting mistakes. Therefore, billing audit at regular intervals is critical for every practice.
What Are the Steps to Perform an Effective Billing Audit?
It depends on you how deep you go into the internal billing audit. However, it is essential to adopt a thorough approach for the best results. An effective medical billing audit consists of four different steps.
Take a look at the following steps that are essential for an effective billing audit:
- Mapping Out the Process and Scope
- Assessing the scene
- Making changes
- Repeat
By performing these steps accurately, practices can carry out a perfect billing audit.
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