Auditing plays a vital role in every business across all industries. The process ensures that the facility adheres to the laws and regulations set out by the overseeing body and the government. It also helps identify the scopes of improvement in the internal process while ensuring a proper revenue management cycle is in place. Similarly in medical practice, audits are done to better the operation by auditing the claims administration. The other is the self-audits of the process to identify the mistakes within the practice and improve them. Medical billing audits in practice become essential at times because they can help find errors in the coding and the billing process. Without the audits, the opportunity to recover from the revenue loss is challenging, mainly when the claims in the medical business are pretty complicated.
Hence, in this article, we will look into the impact of medical billing audits on a practice.
What Is Medical Billing Audit?
Before we go into the details of how a medical billing audit affects the practice, it’s essential to have a clear understanding of what is medical billing audits.
Evaluating and examining the effectiveness of the overall medical billing process of practice, along with the reliability of the clinical documentation, can be stated as medical billing audit. The planned process entails:
- A thorough check and review of all the health records maintained,
- Medical billing data submitted to the insurance companies,
- Monitor the billing practice and process,
- Correction of any incorrect billing practices
When the audits takes place, the practice can be asked to submit the following:
- Clinical records, like x-ray, medical, lab reports, etc.
- Financial records like charges entered, explanation of benefits, account receivable ledger, etc.
- Documents related to policies like those required by the government or the private insurance companies.
Medical billing audits can be categorized into two sections:
Retrospective: The audits is done after the claims are sent to the payers, and it is generally the current providers’ audits retrospectively.
Prospective: The audits takes place before the claims are sent, and some practices follow the prospective audits with new providers.
Now, with a comprehensive idea of what a medical billing audits is, let’s see its effects on practice.
Effects of Medical Billing Audit On A Practice
Apart from the benefits like improving the medical claims ratio and the coding semantics, the medical billing audits impacts the practice in many other ways. Here are some of them:
Better medical claim performance
The detailed medical billing audits allows the practice to better its claim management system and reduce or avoid denials. Typically in medical practice, the denial rate is between 5 and 10%, which eventually has a severe effect on the facility’s cash flow. It ultimately means loss of revenue and the facility unable to provide the proper support to the patients.
Typically the reasons that claim often get denied are due to the facility
- Failing to provide the pre-authorization,
- Inaccurate documentation,
- Errors in claim forms and patient data,
- Errors in coding,
- Duplicate claim submission,
- Missing the claim submission deadlines,
- Lack of coverage due to ineligibility,
- A medical procedure that is considered to be not necessary, etc.
All these factors can be checked and corrected with timely medical billing audits and help the regular and seamless flow of the revenue for better healthcare business.
Improved Compliance In Medical Billing
Medical billing audits help standardize and streamline the medical billing and coding process of the practice. However, it is mandatory that the medical billing and coding procedures used by a medical facility must comply with the HIPPA rules and regulations. Failing to comply with the HIPAA rules, both the practice and the medical billing companycan face legal consequences that can levy huge penalties and black-list the practice.
While ensuring that the practice follows the HIPPA rules, medical billing audits also warrant the facility to comply with the Physician Self-Referral laws, AKS (Anti Kickback Statute), and FCA (False Claim Acts). The audits does spot checks on these and a risk assessment to ensure there is no fraudulent billing and claim activity.
The audits in the medical billing services ensures that standard practice is followed in the office that implements the required policies and procedures. It helps create a stable and positive working environment by streamlining the workflow that is in adherence to the required claiming and billing policies and medical practices. The process not only increases the productivity of the employees but retains employees. In the long run, a regular medical billing audits ensures the practice is cost-effective with improved management and better communication.
Supportive Relation Between Payer & Provider
Just like the importance of the physician and patient, the relationship between the payer and the provider needs to be sustainable in medical practice. For example, when medical billing audits ensure accurate claim submission, there is a lesser issue of faulty documentation that can sour the relationship. Instead, the rewarding attitude between the two can boost the business better for both the payer/insurance company and the service provider/medical billing agency.
Learning From the Medical Billing Audit Results
The result of the audits must be educational for the employees to ensure similar mistakes are not made in the future. It will ensure there are no revenue losses due to the same errors. Hence the medical coding staff must clarify with the auditors, accept the result and find opportunities to improve their work. The audits reports must be used to develop a coding and billing practice benchmark for the coders and have a consistent resource for assistance.
How To Move Forward With Medical Billing Audit?
At 24/7 Medical Billing Services, we specialize in medical billing and coding services. Our certified professionals conduct regular internal audits to ensure that your practice is not losing any revenue for medical coding and billing mistakes. Also, we confirm that the practice complies with the federal and state government health policies and regulations. When you outsource medical billing services to 24/7 Medical Billing Services, we ensure we take care of your revenue management and other compliance while you care for the patients.