Healthcare is a huge field with a plethora of domains and ever-changing policies. Medical billing audit is an important element of healthcare but is often overlooked. These audits ensure that there are no errors in medical billing.
Audits also play their part in a more strategic way to regain lost revenue and ensure compliance in medical billing. In this blog we will dive into the importance of medical billing audits and understand how an effective audit secures a healthcare provider’s financial health.
Let's Start with Understanding Medical Billing Audits
Medical billing audits examine the accuracy and completeness of your billing process precisely, so you do not have to worry about your claims being denied or rejected. It can be considered as a checkpoint to identify the errors that may lead your practice towards revenue loss.
This process ensures that you are adherent to all the ever-evolving healthcare guidelines and regulations. These audits work as a financial health checkup for medical practices identifying the areas that need attention.
Why Accurate Billing Is Paramount?
Accurate medical billing is not only a requirement for compliance, but it is also important for the financial lifeline of healthcare practices. Errors in medical billing may lead your practice to significant revenue losses if they go unnoticed for long periods.
Regular billing audits help you find the errors, making sure that the healthcare providers are fairly compensated.
Identifying The Sources of Lost Revenue
Identifying the spot where revenue loss occurs is the first step towards correcting it. Some common issues include undercoding, overcoding and missed charges.
Overcoding defines the area where excess codes are used which may lead to a higher reimbursement of what it should actually be. Undercoding refers to some codes missed during the time of services rendered which may affect the reimbursement negatively.
Missed charges are the services that are not billed on the claim. Each of these errors will take your practice towards significant financial losses. Let's take a look at some steps to conduct medical billing audits.
Steps to Conduct Medical Billing Audits
An efficient medical billing audit has some key steps:
Preparation:
Determine the scope of audit including the time frame and the types of claims you want to audit. Select a few people within your organization and create a team of people who have an expertise in coding, billing and compliances.
Execution:
Take a random sample of your billing records for maximum precision. This includes checking the correct patient information, proper coding procedures and accurate charge capture.
Technology:
Integrate advanced software technology in your audit process to do a comprehensive check. These tools will help you identify the patterns and inconsistencies more effectively.
Analyzing Audit Findings
Analyzing the results of the audit is very important. This involves understanding the frequency and type of error and their financial impact. This includes identifying the mistakes, when they occurred and how they can be prevented in the future.
Corrective Measures
After completing the audit, it is important to implement the corrective actions and rectify the potential errors. This involves reprocessing the claims, providing specific training for staff and updating your billing process. If you want to decrease the errors in medical billing in future, you must set-up a regular re-auditing process. This ensures adherence with compliance and efficiency.
Integrate Technology
Technology has become an integral part of almost every business today and the same is the case with medical billing. It can be used for automated error detection and predictive analysis. Technology has the power to improve the accuracy and efficiency of audits. Embracing these advancements will improve your billing practice and revenue recovery.
Best Practices for Continuous Recovery
Regular efforts are needed if you want to maintain continuous recovery. Some of the best ways are mentioned below:
Regular Training
Make sure that your billing staff is always up to date with all the latest coding standards and regulations.
Stay Informed
Always keep yourself updated about the frequent changes in healthcare billing regulations and practices.
Invite External Auditors
An external auditor will give you an unbiased opinion about your process. This will help you actually do the right thing.
Why is Compliance Important?
Compliance is an essential element and is mandatory by the government. However, it is not only about following the guidelines. It is important because it keeps the patient data safe and also ensures your reimbursement.
Regular billing audits helps you be in compliance always. This keeps healthcare practices away from legal repercussions and improves their reputation within the community.
Implement Structured Process for Rejections
Rejection management is an important element if you wish to have a smooth revenue cycle. Just like denials, rejections happen due to errors in medical billing. Keeping a close track of the rejections from clearinghouses and notifications from RCM system saves a lot of time and costs.
A lot of healthcare professionals use the 80:20 approach where the team focuses on the top 20 reasons causing 80% of denials. Healthcare professionals shift their focus to denial prevention by implementing processes that foster communication between the physicians, front-end and mid-cycle team members.
By reviewing the major cause of denials, professionals eliminate the root cause through behavioral and systematic changes. The revenue cycle team eliminates major causes of denials.
How Can a Professional Medical Billing Company Help You?
A lot of healthcare professionals' partner with medical billing companies to take advantage of their denial management and coding expertise. Experienced medical billers provide a culture of denial prevention by eliminating the root cause of denial.
Medical Billing companies use a data-driven approach that helps healthcare organizations to enhance the cash flow and boost reimbursements.
Major hospitals lose 3-5% of their revenue due to bad claim processing and revenue leakage. This happens majorly due to inefficient documentation and unaccounted or missed procedures. All of this can be managed easily if you partner with the right medical billing company.
Unify Healthcare Services is one such medical billing company that will solve all your queries related to medical billing. Our expert coders and billers work efficiently with your physicians to decrease denials. We are a company with a long list of satisfied clients who have seen a massive boost in their revenue after handing their billing to us.
Our expert coders are well versed in all the elements of medical billing. We are always updated about the latest changes in the guidelines and provisions. We are focused on creating an efficient revenue cycle process for your practice. We streamline your process in a way that you do not have to worry about any sort of documentation.
We handle all the issues such as eligibility verification, physician credentialing and prior authorizations so you need not bother yourself with that.
Unify Healthcare envisions that every healthcare practice gets reimbursed appropriately. We make sure that all the billing and coding done is precise so you can take care of the patient with peace of mind.
Ultimately you are able to provide better patient care which increases your footfall, enhancing your revenue.
