Why You Should Conduct Medical Billing Audit? - PowerPoint PPT Presentation

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Why You Should Conduct Medical Billing Audit?


Medical billing audits cover all areas of medical billing life cycle starting from insurance verification processes, ICD and CPT Coding, claim submission process, payment posting process, follow-up processes, and denial management processes.  – PowerPoint PPT presentation

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Title: Why You Should Conduct Medical Billing Audit?

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Why You Should Conduct Medical Billing Audit?
What is Medical Billing Audit? Medical billing
audit is a planned process that examines and
evaluates the effectiveness and reliability of
clinical documentation and the overall medical
billing process. This process thoroughly checks
all health records maintained by the practice and
reviews medical billing data submitted to the
payers to ensure that the practice identifies,
monitors, and corrects inappropriate billing
practices. When going through a billing audit,
the practice may be asked to provide clinical
records, which may include medical records,
x-rays, and lab reports financial records such
as entered charges, explanation of benefits
(EOBs), and accounts receivable ledger and
policy-related documentation as required by
providers or the government. Audits can be
conducted either before claims are sent out to
the payers (prospective) or after the fact
(retrospective). Some practices follow the rule
of conducting new provider audits prospectively,
and current provider audits retrospectively.   Sco
pe of Medical Billing Audit
Why You Should Conduct Medical Billing Audit?
Medical billing audits have a more comprehensive
approach than coding audits. Medical billing
audits cover all the areas of the medical billing
life cycle starting from insurance verification
processes, ICD and CPT Coding, claim submission
process, payment posting process, follow-up
processes, and denial management processes.
Medical billing audits are specific to coding and
billing only and do not include the level or
scope of care, medical necessity, pricing
structure, or items or services delivered by
providers.   Advantages of Medical Billing
Audit   Coding compliance Billing audits
provide a way to identify and correct problem
spots before the government or insurance payers
challenge inappropriate coding. You can rely on
billing audits for identifying inaccuracies,
providing instructions on ways to correct issues,
building confidence among the coding staff, and
ensuring to use of up-to-date procedure codes.
Those conducting the audit can identify areas
where staff education and training are needed to
make sure that proper coding protocol is always
followed. Administrative Benefits
Why You Should Conduct Medical Billing Audit?
The administrative staff benefits from medical
billing audits by confirming that claims are true
and accurate and are correctly submitted. Audits
set the standard for the office staff and spare
them unnecessary frustration by creating a
positive, stable work environment and culture of
compliance that attracts and retains talented
personnel. Under-coding, code overuse, improper
unbundling habits are replaced with appropriate
billing for commonly documented procedures. When
policies and procedures are set in place and
followed correctly, the chance of a visit from an
external auditor decreases significantly.   Ensure
compliance Through medical claims audits, the
practice is protected against fraudulent billing
activity and claims. With help of billing audits,
practices can easily verify compliance with
ICD-10-CM, incorrect payments are reduced or
eliminated. The audit may identify reimbursement
deficiencies and reveal ways in which the
practice varies from the national average due to
inappropriate coding. Thus, areas for increased
reimbursement may be revealed and, in turn, boost
revenue. Additionally, the practice benefits when
files are processed efficiently, improper
payments are reduced and claim payment is
optimized. Better relation with insurance
Why You Should Conduct Medical Billing Audit?
An improved relationship with payers is another
perk of a medical claims audit. Payers appreciate
it when claims are submitted accurately. An audit
will reveal any outliers that allow the practice
to identify any problems before a large payer
identifies a problem and requests an external
audit.    Better patient care Medical claims
audits contribute positively to improved patient
care. By tracking and monitoring services and
procedures and educating physicians on providing
patients with positive medical experiences, the
focus of the entire practice shifts to the
quality of care provided. When patients have a
better experience, the result is a
smoother revenue cycle and better patient
outcomes.   Need of External Audits Medical
billing audits can be conducted either by
internal or external auditors called internal and
external audits respectively. Internal audits are
precisely what they sound like, an audit
performed by an internal, billing, and coding
team. Larger organizations might have a dedicated
internal audit group, giving them the key benefit
of performing audits on an ongoing basis.
Why You Should Conduct Medical Billing Audit?
Frequent auditing provides the organization with
information that allows for continuous
improvement in processes and accuracy. External
audits can be an excellent option for a small,
busy practice. They provide insight that
eliminates conflicts of interest and spots
upcoding without regard for its impact on
revenue, something that internal auditors with
even the best of intentions might miss. Theres
also the added benefit of recommendations
carrying more weight when they come from an
external source. External audits, though, arent
a clean substitution for internal. Even
organizations that conduct ongoing internal
audits should have an independent, external audit
performed annually. Overall, small practices
might find it useful to lean on one of the many
companies that specialize in external audits,
especially if they dont have the resources to
conduct consistent periodic internal
reviews. Just receiving reimbursements against
submitted claims is not sufficient. Each and
every revenue cycle activity must be audited
properly to avoid any inefficiencies or
malpractices.  Medical Billers and Coders
(MBC) can assist you in conducting external
audits as per your medical specialty. As a
medical billing company, we provide all revenue
cycle services including external audit. To know
more about our medical billing audit services,
contact us at info_at_medicalbillersandcoders.com/888
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