Know the Value and Purpose of Medical Coding and Billing Audit

Medical billing audits look into every aspect of the medical billing process.

Fremont, CA: An internal medical billing and coding audit is a procedure for examining and evaluating clinical data as well as the entire medical billing process. This procedure carefully verifies the practice's health records and reviews medical billing data given to payors to guarantee that the practice discovers, monitors, and corrects incorrect billing practices.

Clinical records, such as medical records, x-rays, and lab reports; financial records, such as entered charges, explanation of benefits (EOBs), and accounts receivable ledger; and policy-related documentation, as required by providers or the government, are all collected during a coding and billing audit.

Audits can also get performed either before or after claims are sent out to payors (prospective) (retrospective). Some practices follow the guideline of performing prospective new provider audits and retrospective existing provider audits.

Unlike coding audits, medical billing audits take a complete approach. Medical billing audits look into every aspect of the medical billing process, including insurance verification, ICD-10-CM, CPT coding, claim submission, payment posting, follow-up, and rejection management.

Advantages of Medical Billing Audit

Coding compliance

Before the government or insurance payors contest erroneous coding, billing audits give an opportunity to discover and resolve issue regions.

Billing audits may help businesses spot mistakes, give advice on how to fix problems, instill trust in their coding personnel, and ensure that users are using the most up-to-date procedure and diagnostic codes. In addition, those performing the audit will be able to see areas where staff education and training are required to ensure appropriate coding methodology gets followed.

Administrative Benefits

Medical billing audits aid the administrative staff by ensuring that claims are valid and accurate and that they are submitted appropriately. By fostering a good, stable work environment and a culture of compliance that attracts and maintains outstanding employees, audits set the norm for office staff and save them unneeded frustration. Under- and over-coding, code misuse, and poor unbundling behaviors get eliminated in favor of good service and process invoicing. When rules and procedures are established and followed appropriately, the likelihood of an external auditor's visit is greatly reduced.

Ensure compliance

The practice can defend itself against fraudulent invoicing and claims by conducting medical claims audits. The audit may show payment issues and instances in which the practice differs from the national norm owing to coding errors. Higher reimbursement opportunities may get discovered, resulting in increased income. Additionally, when files get handled quickly, incorrect payments are decreased and claim payment is maximized, the practice benefits.