Medical billing is a complex task that requires great precision and dedication. Errors are very common in the field which might lead your practice towards huge revenue losses. That is why self-auditing your practice to ensure compliance is very important for any practice. It checks if your organization handles documentation, coding, and billing practices appropriately.
One of the major reasons for self-auditing is to identify any potential areas of concern which could put the physician’s practice at risk during coding audits. The officer of the Inspector General (OIG) of the U.S. Department of Health and Human Services states that self-auditing can be used to determine that the bills are accurately coded, documentation is accurate, and the services provided are necessary. The codes must reflect all the services rendered and should not include any unwanted or unnecessary service.
Annual audits are a good practice which can help practice determine where they are lagging behind. It determines clear upcoding and billing issues before the insurance company takes note of the same. These audits can also help you figure out any lost revenue issues that might be keeping your practice behind.
The frequency of audits can be decided upon the size of practice. It does not need to be permanent, but a good practice will be to internally audit your practice quite regularly for say a year or so. After that you can conduct an audit yearly or half-yearly.
Let’s assume that your practice just started a new procedure as a service. It is important to monitor the new service in the beginning. Self-auditing the new process a few times within 90 days is good practice.
Hiring a physician for your practice is also a great practice too. They can help you with auditing compliance too. If a practice performs weekly audits, the findings can be brought up to the managers who can take steps and rectify the errors.
There Are Two Types of Reviews Recommended by the OIG
Standards and Procedures Review
These are the standards which need to be updated to reflect any government changes in regulations. These are current and complete reviews.
Claim Submission Audits
This ensures that the coding, billing and documentation is in compliance with the payer and federal guidelines. This ensures that the services rendered are reasonable and support medical necessity.
Steps To Develop and Comply OIG Self-Auditing Requirement
- Define the roles and accountability within your organization
- Assign a strong coder who can review the medical bills and records to ensure the accuracy of information in coding
- Accounts Receivable works to confirm that the charges are accurate
- The medical coder verifies that the medical records are complete, and all the codes are documented and are currently being treated.
- Deduce a time frame for regular audits. The OIG recommends quarterly audits.
- Decide the number of charts which need to be reviewed.
- Specify the types of reviews. For instance, you should review ICD-10 codes, charges, and provider level of care for outpatient accounts. You must also check if their documentation supports the level selected.
- Reports must include all your findings regardless of their effect on your organization. It includes the education resources so the coder can improve your accuracy.
- Conduct a meeting with the billers and the coder to go through the results and office education pointers.
Additional Guidelines
All the employees involved in coding and billing should be on alert for potential errors that may happen during the process. They must be trained to look for red flags which indicate potential problems.
Problems should be communicated to respective managers so that they can be dealt with. You must also appoint a manager for auditing compliance. The manager will be responsible for investigating reports of the Red Flags or potential errors.
If you do not have the required workforce, it is advisable that you hire an external auditor. You can hire someone from within the office who has a good understanding to perform self-audit.
It's true that self-auditing takes some time, but it only helps your practice to excel. Self-auditing carefully can help you create a preemptive strategy to handle coding and billing problems before they actually turn out to be a nightmare.
Importance of Self-Auditing
Self-auditing is important for a variety of reasons. It helps the physicians understand where they lag and what could be the potential reasons for denial of claims. It also makes them aware of compliance to ensure that they are in adherence to all the guidelines set by the government as well as the insurance payer.
Self-auditing is important to ensure accurate documentation, coding and billing practice. If you are already audited, it decreases the chances of facing any issues during an external audit. Once you have completed the baseline audits, it is recommended to develop an auditing compliance plan for your staff. This acts as a blueprint of documentation, coding and billing for your staff to follow.
Partner with a Good Healthcare Billing Company
The word “Audit” gives a sense of fear and anxiety to some healthcare providers, however, once the audit has been developed and integrated into the process, it becomes the best friend for providers.
However, not every practice has the resources to define an audit process. This is where professional medical billing companies like Unify Healthcare Services can help you. Unify Healthcare Services is a well-established name in the field of medical billing with a huge list of satisfied clients.
It can help you create a clear and proactive understanding of the auditing process. It helps the practice catch potential error patterns which may lead your practice towards bad revenue management.
Once a simple and understandable auditing process is put in place, the practice feels relaxed.
