A medical billing audit is the way in which a healthcare facility can monitor its quality and compliance. All of the parts of handling a medical practice get factored into an audit, most notably being all of the processes that bring about reimbursement. All of the steps that go into reimbursement are carefully observed to ensure everything is in compliance with the regulations in your area. Let’s take a look at some of the items that should be on a medical billing audit checklist.
Patient Record Verification
One of the first steps to follow is to verify the patient’s authorizations and identifications. Information on patients, such as the day they visited your facility, where service was provided, and their name all have to be accurate and in line with what the claim documents say.
You also have to look at your patient’s insurance coverage plan to see if that plan was valid and in use for whichever date the services were provided.
Verification of Provider Information
It’s not just the patient’s details you need to verify; it’s also the information of the provider who performed the services and crested the charges. You should only ever have providers with sufficient licensing and credentials working with patients, so you’ll have to check to make sure you’re working with a legitimate provider.
Verifying Your Electronic Health Records (EHRs)
For your medical billing audit checklist, you need to match all of your records’ IDs, confirm whether or not the proper dates have been entered for each visit and procedure that has been provided, be sure that information has been filled out completely, and confirm whether or not previous medical history has been correctly recorded. There should also be patient information pertaining to factors such as smoking, food and drug interactions, substance abuse, allergens, and alcoholism.
Verifying Diagnostic Reports
For any medical billing audit, you need to look at the possible disease conditions of your patients and be sure that whatever diagnostic procedures are being used are suitable to test for these conditions. Radiological results have to include the image interpretation, and they must get authorized by whichever provider interpreted the results. For lab results, they must be done with all of the correct authorizations and dates.
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