Things to Know about Medical Billing Auditing

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Things to Know about Medical Billing Auditing

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Introduction

• Medical Billing is a comprehensive and intricate
  process requiring meticulous and precise handling
  at all level and scope of service.
• Quality standards at each scopes needs to be
  assessed to ensure they are meeting the maximum
  reimbursement criteria. Medical Billing Auditing
  is mandate for each scope of service for a smooth
  and profitable Revenue Cycle Management.
• Understanding the importance of Medical Billing
  Auditing and involving audit at the right time
  can save a lot of claims from denials and revenue
  loss.

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• In this article let us discuss on the things to
  know about Medical Billing Auditing to aid
  improvised financial system for your Medical
  Billing.
• Quality claims keeps Medical Billing revenue flow
  intact, however ensuring the quality percentage
  does not diminish below the standard margin
  necessitates consistent and regular audits on the
  below area.

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Medical Records and Documentation
Claim Duplication
Coding Audit
Attention to Codes
Medical Billing Audits
Charges and Fee Schedule
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Medical Records and Documentation

• Audit the patient records for accuracy and
  completeness of the given information.
• Precise documentation is crucial for billing and
  coding functions to draw maximum collections.

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Coding Audit

• Irrespective of the specialty and complexity
  level coding errors are inevitable.
• Regular coding audit should be a part of your
  billing process.
• Based on the error percentage and with any
  changes in the coding protocol or guideline,
  inclusion of new coders or new specialty can
  require increased attention and frequent audits.

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Attention to Codes

• Verify the procedure code CPT, diagnosis code ICD
  10 CM and modifiers are appropriate to the given
  medical records.
• Coding diagnosis vs. symptoms, primary and
  secondary coding levels, code first or combo code
  guidelines are few areas to be crosschecked to
  ensure they are not causing any denials.

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Charges and Fee Schedule

• Auditing your charge entry process frequently
  should be a mandatory process to ensure you are
  getting paid as per the fee schedule.
• Being ignorant of the changes in fee schedule and
  billing the claims with the out dated value can
  seriously affect your financial system

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Claim Duplication

• Claim duplication can be a reason for denials or
  rejections.
• Medical Billing audits should focus on verifying
  claim duplications to avoid such scenarios
  depreciating possible reimbursement.

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Medical Billing Audits

• Unlike Medical Coding audits, Medical Billing
  audits can be much more comprehensive covering
  complete billing scopes of services from RCM
  cycle.
• Given below is the list of billing scope that
  needs regular audits for cleaner claims and
  faster payments
• Insurance Verification process
• Demographic Entry
• Claim submission process
• Payment Posting
• AR follow up and Denial Management

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Benefits of Medical Billing Auditing

• Regular audit are essential part of every Medical
  Billing Process to ensure maximum benefit from
  business financial goals. Medical claims auditing
  at various level not only captures errors but
  also aids in educating the team involved in
  claims processing to avoid repetition of such
  errors or slips.
• Medical claims audit can be internal or external,
  the respective advantages from each type of
  Medical Claims Auditing. While internal audits
  gives the coders and billers a stand to leverage
  on if things did not work out, External Audits
  are more educative and can help curb
  re-occurrence.

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About e-care

• E-care is one of the leading Medical Billing
  Companies providing complete Revenue Cycle
  Management Solutions along with Billing and
  Coding Audits.
• With more than 80 clients across various states
  in US and being a multi-specialty billing company
  e-care can provide dedicated and focused billing
  services to all our clients ensuring maximum
  collection and reduced denial percentage.

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THANKS!

• To know more about e-care and its services
• call us 1-813-666-0028
• log on to www.ecareindia.com

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