MEDICAL BILLING AUDIT: A GUIDE FOR OPTIMAL GROWTH OF YOUR PRACTICE

Due to its intricacy, the medical billing process provides more room for error, irrespective of the specialty of billing experts. Therefore, a stringent review of the Medical Billing and Coding process of medical practice is required to ensure the accuracy of clinical documentation, codes, and Claim Submissions. This process is carried out by the medical billing audit, which involves evaluating and examining medical and financial data of practice. Frequent Medical Audits are crucial for the smooth functioning of practice and ensure stable financial outcomes.

Types of Medical Billing Audits: 

Medical Billing Audits are done in multiple ways, but the intended results are always the same. When the audit is carried out by the team, which is part of the healthcare organization being audited, it is an Internal Billing Audit. Larger medical practices hire a team of auditors to ensure billing audits around the year. While the smaller healthcare practices take medical billing audit services from some external entity, which carries out the operations on behalf of medical practice, it is named External Billing Audit. Both types have their benefits, as an internal billing audit ensures a regular check on the performance, and an external billing audit paves the way for independent and more reliable insight. Therefore, most organizations go with both to have a holistic idea. 

Medical billing audit is important not only for compliance but to bolster revenue in several ways, as underneath 

Check on Staff Efficiency

Medical billing audit provides insight into the performance of the staff. It serves as a data analysis tool to provide information on staff efficiency. It requires team effort and dedication from the staff to get the desired outcomes.

Ensure HIPAA Compliance

Medical practice has to ensure compliance with Medicare and federal or state government regulations such as HIPAA (Health Insurance Portability and Accountability Act of 1996) failure, which may result in termination. Auditing your practice can keep your practice in line with these regulations.

Traces Errors and Faulty Practices

Medical billing audit provides a chance to correct an error before some private or government authority catches it. The error might come from a mistaken coding entry or medical reporting. These errors, when diagnosed, can be corrected to avoid undesired consequences, including penalties.

Protection Against False Claims

Clean claim submission is encouraged with protection against false claims or billing activities as it detects the risk areas in the billing process. Rejected claims require more revenue for resubmission, which adds to the plight of healthcare practices. Therefore, a medical billing audit protects from making false claims and billing operations.

To Conclude

Medical billing audit, as an integral part of Revenue Cycle Management, is considered a turn-key solution for all the malpractices and errors by the medical practice with the diagnosis and correction of errors and faulty areas. Thus, a billing audit contributes to the smooth functioning of revenue with bits of help in bolstering revenues and ensuring a minimal chance for an error, which is vital for profitability as well as the professional outlook of the medical practice.