What Is Medical Billing Audit?

Medical billing audit is a method for reviewing and recommending enhancements to coding, billing, and documentation to prevent a third-party audit, identify under coding/over coding, and other discrepancies that might result in disciplinary action from third-party carriers, federal, state, or other regulatory agencies. A lot of medical billing companies like ParkMedicalBilling provide audit services for their clients. The audit reflects the status of a provider or the clinician based on staff putting information on the encounter. So, judging the encounter, you’ll determine whom you need to help educate to make sure you’re reimbursed fully. It will help reduce your denials. It will help in getting your revenue cycle to be on a more even path. So, even though we educate staff on how we want it to be done, we have to make sure that those pieces are being followed through because sometimes they fall through the crack.

The Importance of Audits

Medical billing audits are of great importance as they help you get a picture of your organization and the steps you will need to complete your services. As you provide these services, you should be able to get paid for the services and get paid for them in the appropriate amount, and a lot of that base is based on the documentation or the information you put down. Therefore, sometimes understanding what pieces you need to have or using billing audits as an educational tool to help everybody in the office make sure they’re all putting these pieces together so that you’re getting reimbursed for the services you provided.

Why you should perform an audit

Firstly, it enables identifying and suspicions of practice deficiencies in the coding, billing process, documentation, service provided not billed, payment denials, rejections, and requests for additional information. The recommendations for further details change your revenue cycle. It causes the revenue cycle to stop until all relevant information required is resubmitted.

Some kinds of treatments and visits will always be questioned by the insurance companies they want the proof, but is your proof enough? Medical billing audits there could be quite helpful. It also helps improve your collection rate as it is based on your accounts receivables. If the collection rate is building at a constant rate, it might be because of how the claims are going through; an audit would highlight those as well.

What Medical Billing Companies

Great medical billing companies use a combination of cutting edge technology, real-time online reporting, experienced staff, and a complete understanding of the ever-changing rules of insurance guidelines. Medical billing companies use custom scrubbing software that ensures your claims go out clean every time. Since they customize to your practice’s individual needs, they truly eliminate human error. The claims are checked for insurance verifications, modifiers, authorizations, correct providers, current CPT codes, schedules, and anything else your office needs before going out. No more denials for the simple things with their custom daily denial report; usually the account managers can address your denials within 5 to 21 days of receiving them.