Things to Know about Medical Billing Auditing - PowerPoint PPT Presentation

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Things to Know about Medical Billing Auditing


Medical Billing Audit ensures whether accurate medical billing is performed or not and Obliterate billing errors in claim processing. – PowerPoint PPT presentation

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Title: Things to Know about Medical Billing Auditing

Things to Know about Medical Billing Auditing


  • 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
  • In this article let us discuss on the things to
    know about Medical Billing Auditing to aid
    improvised financial system for your Medical
  • 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.
Medical Records and Documentation
Claim Duplication
Coding Audit
Attention to Codes
Medical Billing Audits
Charges and Fee Schedule

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.
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.
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.
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
Claim Duplication
  • Claim duplication can be a reason for denials or
  • Medical Billing audits should focus on verifying
    claim duplications to avoid such scenarios
    depreciating possible reimbursement.
Medical Billing Audits
  • Unlike Medical Coding audits, Medical Billing
    audits can be much more comprehensive covering
    complete billing scopes of services from RCM
  • 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
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

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.

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