Importance of Medical Billing Audit

Auditing is a process many are familiar with. When it comes to medical billing audit, all the medical records are examined to make sure that it is maintained according to the standard rules of the medical field.

Reading the following article, you will understand the scope it covers as well as its advantages.

Scope of Medical Billing Audit

When it comes to the billing audit, there are certain areas which become the checkpoints. Following are the areas where auditing is done.

Auditing Medical Records and Documentation

It involves auditing all patient records maintained by the organization. Record and documentation require precise maintenance because they are of importance for further processes of medical billing and coding to bring in maximum reimbursement.

Auditing medical codes

When it comes to coding, there are certain mandatory aspects one has to follow. The coding must be down according to the updated medical coding protocols while following CPT codes and ICD-10. Any errors in the medical codes can cost you a lot later. Hence it is necessary that you practice coding audits on a regular basis.

Auditing Charge Entry

This process is essential, especially if you wish to optimize your financial process. You have to be aware of your fee schedule to ensure you are getting your payment according to it. It will be one of the best steps you have taken to ensure your reimbursements.

Auditing Claim Duplication

This area certainly requires auditing as most of the claim rejections and denials occur due to claim supplication. Monitoring and auditing this area would reduce your rejection and denial rates and also save you money.

Auditing Medical Bills

The process of medical billing includes various areas- Insurance Verification process Demographic Entry Claim submission process Payment posting process AR follow up processes Denial Management processes When it comes to medical billing audits, the above checkpoints are considered. If you maintain a regular billing audit, it will make your claim submission process and reimbursement process seamless to a greater extent.

Advantages of Medical Billing Audit

There are several advantages of medical billing audit, due to which you as an organization must practice it regularly. Below mentioned are the advantages that a billing audit provides:

1. Reduces errors in coding and incomplete information. It helps identify the errors and correct them.
2. Prevents duplicate claims and unnecessary billing.
3. Maintains proper and updated records and documentation.
4. The perfect way to find under coding issues.
5. Best for identifying outdated and incorrect codes.
6. Identifies reimbursement issues.

Need for External Audits

External Audit is a necessary part of a healthcare organization. Check out the reason why it is necessary:

1. The internal auditors might face barriers when it comes to assessing all documents to manage fraudulent risk management. But an external audit will dig deep enough to make your organization safe from fraudulent activities.
2. The external auditors are experienced and experts when it comes to auditing.
3. The external auditors are not influenced or affiliated due to any obligation, hence can execute their task better.
4. They remain up to date with the industry and practice proper practices according to guidance. This will help you out with detecting errors.
5. External auditors are more reliable when it comes to identifying issues and informing the authorities of management about areas that require attention.
6. They will also be the perfect people to provide you with the required suggestions to solve your issues.

This is enough to make your billing audit efficient and solve various major issues in your organization. Therefore make sure you execute this process from time to time.

Conclusion

The article explains why medical billing audit is of importance. Especially when it comes to optimizing your revenue cycle and identifying various loopholes, due to this, it is essential that you practice both internal and external audits on a timely basis.