Medical Billing is a comprehensive and intricate process requiring meticulous and precise handling at all level and scope of service. Quality standards at each scopes needs to be assessed to ensure they are meeting the maximum reimbursement criteria. Medical Billing Auditing is mandate for each scope of service for a smooth and profitable Revenue Cycle Management. Understanding the importance of Medical Billing Auditing and involving audit at the right time can save a lot of claims from denials and revenue loss. In this article let us discuss on the things to know about Medical Billing Auditing to aid improvised financial system for your Medical Billing.
Quality claims keeps Medical Billing revenue flow intact, however ensuring the quality percentage does not diminish below the standard margin necessitates consistent and regular audits on the below area.
Medical Records
and Documentation: Audit the patient
records for accuracy and completeness of the given information. Precise
documentation is crucial for billing and coding functions to draw maximum
collections.
Coding Audit: Irrespective of the specialty and complexity level;
coding errors are inevitable. Regular coding audit should be a part of your
billing process. Based on the error percentage and with any changes in the
coding protocol or guideline, inclusion of new coders or new specialty can
require increased attention and frequent audits.
Attention to
Codes: Verify the procedure code CPT,
diagnosis code ICD 10 CM and modifiers are appropriate to the given medical
records. Coding diagnosis vs. symptoms, primary and
secondary coding levels, code first or combo code guidelines are few areas to
be crosschecked to ensure they are not causing any denials.
Charges and Fee
Schedule: Auditing your charge entry
process frequently should be a mandatory process to ensure you are getting paid
as per the fee schedule. Being ignorant of the changes in fee schedule and
billing the claims with the out dated value can seriously affect your financial
system
Claim
Duplication: Claim duplication can be a
reason for denials or rejections. Medical Billing audits should focus on
verifying claim duplications to avoid such scenarios depreciating possible
reimbursement.
Medical Billing
Audits: Unlike Medical Coding audits,
Medical Billing audits can be much more comprehensive covering complete billing
scopes of services from RCM cycle. Given below is the list of billing scope
that needs regular audits for cleaner claims and faster payments:
- Insurance Verification process
- Demographic Entry
- Claim submission process
- Payment Posting
- AR follow up and Denial Management
Benefits of
Medical Billing Auditing
Regular audit are essential part of every Medical Billing
Process to ensure maximum benefit from business financial goals. Medical claims
auditing at various level not only captures errors but also aids in educating
the team involved in claims processing to avoid repetition of such errors or
slips.
Medical claims audit can be internal or external, the
respective advantages from each type of Medical Claims Auditing. While internal
audits gives the coders and billers a stand to leverage on if things did not
work out, External Audits are more educative and can help curb re-occurrence.
About e-care
E-care is one of the leading Medical Billing Companies providing complete Revenue Cycle Management Solutions along with Billing and Coding Audits. With more than 100+ clients across various states in US and being a multi-specialty billing company e-care can provide dedicated and focused billing services to all our clients ensuring maximum collection and reduced denial percentage. To know more about e-care and its services call 1-813-666-0028 or log on to www.ecareindia.com