What is Medical Bill Auditing?

Healthcare providers lose a lot of money due to billing errors. A medical billing audit is a step towards stopping it. It refers to a full-fledged review conducted to ensure the accuracy of claims submitted to insurance companies.

A medical billing audit is done to review and inspect the medical bills and records by experts, which ensures that everything is correct and under the guidelines determined. It is an important aspect in the world of healthcare.

Checking up on healthcare provider’s financial practices is essential to ensure that hospitals, clinics, and doctors prepare the bill only for the services rendered. Just like regular health check-ups, medical billing audit catches the mistakes before they can tarnish your financial health.

Incorrect billing can lead to hospitals losing money and, in some cases, it forces the patient to spend more money than they should. Errors in medical billing will impact your organization's revenue.

Scope of Medical Billing Audits

Medical billing audit is important to keep organizations in check with the guidelines.

But you might be wondering what exactly does a medical billing audit cover?

Let's dive a little bit further and understand the scope of medical billing audit.

Coding Accuracy

An audit ensures that all the medical procedures match with the correct billing codes.

Billing Procedures

Keeping a check on how the bills are made, sent and followed up on.

Adherence to Guidelines

Ensuring adherence to all the policies to meet the guidelines of healthcare industry.

What is Medical Bill Auditing?

A medical billing audit keeps your finances tidy and straight, but this is just one aspect. It is not only about keeping your organization safe but also about accuracy and ensuring the sustainability of healthcare services.

This creates a trustworthy and efficient healthcare system for patients as well as providers. Medical billing audit is not a one-time thing. It requires consistent efforts to keep healthcare provider’s financial health in shape. Ensuring that every provider is getting reimbursed for providing essential care is paramount.

Benefits of Medical Billing Audits

When it comes to managing the finances and maintaining a smooth revenue cycle, a medical billing audit is essential. Let’s understand the breakdown and stroll through the benefits.

Improves Billing Efficiency

Medical billing audits reduce errors drastically and enhance reimbursement rates. Audit officials examine all billing practices to ensure accurate claim filing.

They ensure that all the charges mentioned on the patient’s bill are correct and justified. Precision is a key factor in billing because the minutest mistake will mean a bigger headache in the future.

Compliance with Regulations

Healthcare is a complex field and so are the guidelines related to it. Medical billing audit ensures that every code is accurate, and the bill is presented only for the services rendered.

This includes staying adherent to frequently changing healthcare laws. An audit saves you from legal repercussions and hefty fines by ensuring compliance with healthcare guidelines.

Enhances Revenue Cycle Management

Every healthcare practice and organization are a business at the end of the day. Accurate billing is not only important for keeping your papers straight but also for the revenue of the organization.

Precise billing leads to better revenue cycle management which means that the healthcare providers are getting paid correctly and at the right time. It keeps the process smooth and maintains a healthy revenue cycle. Around 12% of claims submitted have inaccurate codes. These errors lead directly to claim denials resulting in financial instability for the practitioner.

Types of Medical Billing Audit

Internal Audits

Internal audits are conducted by the healthcare organization’s own team. Having an internal audit team means that you can regularly keep a check on your billing process.

This way you can determine any discrepancies early and keep everything running smoothly. You don’t need anyone to tell you about any issue.

External Audits

External audits are conducted by an external team who can be from the regulatory agencies or third-party auditors whose major task is to conduct audits.

These audits bring in new perspectives and help you find things which you might have missed. They help you ensure that you are compliant with all the regulations and standards.

Focused Audits

This type of audit works like a sniper in the world of audit. They focus on specific areas which have higher chances of risk, or some issues concluded by the pattern.

Every healthcare individual will understand that some services, departments or billing procedures need extra attention. It's a proactive approach to determine and tackle problems that are most likely to happen.

Random Audits

These audits are conducted randomly, and any area of your billing process can be chosen for a review. This ensures that all the areas of the billing process are regularly monitored and evaluated.

This also helps to keep everyone on their toes to maintain high levels of accuracy.

Medical billing audit is more than just a necessity, it is a process to spot errors and avoid legal headaches. This ensures that your billing process is as healthy as possible.

How to Audit Medical Billing?

Medical billing audit is crucial for ensuring that your healthcare billing practices are accurate, efficient, and adherent to all regulations. In this guide we will simplify the process into manageable steps which ensure that you can conduct an extensive audit

Define Your Objectives

You must decide that you need an extensive audit or concentrate on specific areas, such as a particular coding practice or high-risk services.

Determine what your audit aims to uncover such as pointing billing inaccuracy, adhering with coding standards, and assessing the current billing process’s effectiveness.

Assemble an Audit Team

Designate the responsibility of conducting audits to some of your employees who you feel are dedicated towards the same vision you follow. Also hiring someone from outside your team can be great practice.

Bringing in experts who are specialized in medical billing audits is very helpful to ensure unbiased evaluation.

Collect Accurate Documentation

Accurate documentation consists of collecting billing records, health records, payment records, and insurance claim forms for the audit period.

Check these documents for accurate information, collect billing code application, adherence to payer guidelines, and consistency with clinical documentation.

Conduct the Audit

Random selection of billing is the best way to figure out the discrepancies and inconsistencies. If you find concerns with certain areas, you can concentrate on these aspects.

Implement a detailed checklist to review all billing and coding facets systematically.

Analyze the Issues

Compile all your audit findings, highlighted errors, discrepancies, and look for concerning patterns.

Find the cause of these issues, such as lack of training, outdated software, or ambiguous billing policies.

Report and Implement Changes

Document the entire procedure and note the findings. Also suggest recommendations for improvement and add any important corrective actions.

Team up with relevant people in your process who are responsible for correcting the issues found. This involves training the staff, introducing new controls, and revising the billing processes.

Track Regular Progress

Make sure you track the effectiveness of the changes made through the audits so that you can have a proactive approach towards the process.

Regular audits must be a part of your ongoing efforts to maintain billing accuracy and compliance. This must be done until you find the most efficient way to improve your practice.

Once you reach your optimum performance, you can get yourself audited after a decided time period.

Conclusion

You must have understood the importance of regular audits in the field of medical billing. It is important not only to maintain a good reputation but also to be adherent to all the guidelines set by the government as well as the insurance payer. If any discrepancy comes forward while a medical billing audit is in place, it hampers your process financially and also tarnishes your image

However, being compliant with ever evolving compliances and provisions is a gruesome task and one cannot expect healthcare providers to be proficient in all of this.

They already have a tough job to do!

It is advisable to hire or partner with medical billing companies such as Unify Healthcare Services that can take care of your entire billing process from the first appointment of patient to the last visit. Every detail of the treatment is taken into account and placed with adjacent codes accurately.

Unify Healthcare Services is a well audited medical billing company which takes care of all your medical billing and coding so that you can focus solely on providing the best patient care. The experts at Unify healthcare services are well versed in all the codes and are always updated with the latest changes in provisions.

We envision making billing easy and efficient for every healthcare practice so that they can focus more on providing the best patient care and be less stressed about their revenue.