What Is Medical Billing Audit?
A medical billing audit is a process performed to evaluate clinical documents. Verify the accuracy, reliability, and validity of records maintained by medical facilities and review billing documents submitted to payers. Auditing allows for the detection, monitoring, and correction of inappropriate billing practices.
Detail: Expectations from the medical billing audit are to ensure good quality patient care at the facilities and providers are educated on documentation on guidelines. A successful medical billing audit checklist can completely screen the revenue cycle management at the facility and optimize it to make sure appropriate payment is received per treatment. It also empowers you to defend against malpractice litigations, health plan denials, and audits from state and private insurance companies.
NAHL can help you in identifying the specific scope of an audit, use the appropriate tools to perform the audit, adhere to a medical billing audit checklist, report the findings of the audit, and provide ideas to correct the errors and educate the staff. This would enable you to safeguard your patients and receive the appropriate reimbursements and avoid risking payment litigations.
Why Medical billing /practice Audit is essential?
- Minimizing claim denials as a result of incorrect coding or inadequate documentation.
- Identifying outliers before payers request an internal audit from the practice.
- Disclosing differences from national averages due to incorrect coding.
- Avoiding a RAC audit or requests from federal contractors for medical record documentation.
- Ensure appropriate paperwork that supports reported services and procedures.
- Detect extra payments and prevent false claims obligations.
- Recognize reimbursement inadequacies.
Medical billing audit checklist.
- All patient records have valid IDs.
- All patient records contain the necessary biographical information.
- The name of the caregiver includes in each chart.
- Accurate medical history contains audited patient records.
- Physical examinations have been documented in patient records.
- Collaboration evidence between primary care and specialty care physicians.
- Every medication and refill is documented.
- Medication information sheets are used.
- All missed or canceled procedures are documented.
- Correctly assigned and formatted medical codes.
- Medical codes for ancillary services.
- Use templates for billing documents.
