STEPS TO CONDUCT A SUCCESSFUL MEDICAL BILLING AUDIT

An audit is a periodic assessment of your medical practice according to the current billing and documentation standards. The purpose of performing a billing audit is to show the depth of the audit. A thorough approach to execution will produce actionable and better results. A successful billing audit is the only way to navigate billing errors and rectify documentation lags. There is no one-size-fits-all approach to performing the complete audit for different healthcare organizations. In order to get standardized results, practices should consider certain steps.

How To Perform Successful Medical Billing Audit With Maximum Precision?

An audit helps to pin out the billing mistakes and prevent them from occurring repetitively. It acts like a medicine to solve billing issues that can affect the overall health of your practice. The way an audit is performed says a lot about the validity of the results. The findings of an audit count for the growth of the medical practice to increase revenue growth. The outcomes of a successful billing audit highlight the major reasons behind fraudulent claims, false billing, wrong coding, under-coding, up-coding, and documentation deficiencies. Physicians Revenue Group, Inc. has a team of great professionals who help you recognize and adjust errors according to the latest healthcare standards.

Step 1 - Map out the scope and process

There is a reason behind every audit, followed by a particular scope on how to perform it. The process to perform a successful billing audit should cover all billing frontiers like patients’ documents, claims, and denied with complete EOB. To maximize the scope of an audit, one must not leave any useful information or resources that can help execute a successful billing audit effectively. The purpose of the scope is to uncover the process of executing an audit and help providers gain precise outcomes.

The first thing to consider is the overall information provided by practitioners, patients, and billing staff to identify loopholes.
Hire a third-party audit team who works as an external consultant and conducts the review. Unlike other external auditors, Physicians Revenue Group, Inc. has the subject matter expertise to give unbiased commands for the betterment of your practice.
Plan to find certain medical billing audit tactics. The right way to access medical charts and documents is to randomly select and analyze certain files to discover under-coding, over-coding, and unbundling.
Write down everything noticed during the process as a formal audit plan.

Step 2 - Assess the scene

It is important to assess the billing reports to find out the unforeseen billing and coding mistakes in the medical charts. While evaluating, also compare the past vs. recent pattern of filling documents to identify discrepancies.

Run a comparative analysis between the physicians’ billing patterns with a standard pattern from the latest industry benchmarks issued by the insurance carrier.
Run a report outlining the reimbursement process for your CPT codes. To ensure that each payer instantly provides payment approval, you can compare the results with the covenant terms.

Step 3 - Make adjustments

Set an improvement goal, such as lowering the percentage of denied claims or raising revenue per patient, armed with the above-mentioned information.
Get payers to pay their agreed rates accurately and on time by making a concerted effort to do so. Perform as many follow-ups as needed to create a strategy for late payment handling.
Deal with any internal issues and educate your team and providers on strengthening the weak areas.

Step 4 - Repeat

Make audits an ongoing practice. If you handle medical billing in-house, you should Conduct an internal medical billing audit at least once a year. Big practices may carry them out as frequently as once every three months.
Create protocols for your medical billing business to facilitate auditing. Monitor net collections and run periodic reports.

Conclusion

With a medical billing audit company like Physician Revenue Group, Inc., one can reduce the odds of inducing billing audits and improve the overall revenue cycle management. Only a proactive and experienced team with established practice, expert knowledge, and helpful billing audit tools can let you identify audit-inducing problems and manage claims.

Physicians Revenue Group, Inc. has enough experience to efficiently carry out billing and coding improvements. We know how to protect your healthcare facility from the potential hazards of wrong billing and delayed claims. Our experts help you to streamline your medical practices, improve revenue, and trim overhead costs. Based on your healthcare-specific needs, we also provide customized solutions, including medical billing services.

Frequently Asked Questions

What does a Medical Billing Audit involve?

It is a Complete review of the medical billing process, medical codes, documentation, the Billing process, medical claims, and denials within a practice. A successful billing audit ensures that your practice is HIPPA compliant and adhering to regulations. An audit provides comprehensive insights into your billing process and identifies errors and areas for improvement.

Who is responsible for conducting a Medical Audit?

Professional auditors should perform a successful billing audit. Physicians who manage their billing in-house can conduct these audits within their practice or outsource to a third-party medical billing company. These professionals use the latest techniques and tools to perform an audit and provide you with the best results.

What are the consequences of not performing a Medical Billing Audit?

Suppose a medical practice does not perform a billing audit, which can cause severe damage to the practice. It can lead to financial loss because of inaccurate coding, Upcoding, Undercoating, Wrong documentation, inaccurate patient information, etc. If practices do not notice these errors, they will face legal issues and financial penalties, which will damage the practice’s reputation and affect its incoming cash flow.

How frequently should Medical Billing Audits be conducted?

Ideally, practices should perform medical billing audits quarterly or annually, but sometimes, it depends on the practice’s needs, practice Size, volume of the claims, complexity, and other requirements. If your practice is working on a large scale with different payers, then you should perform an audit quarterly or biannually to ensure the accuracy of your claims and the billing process.