It is essential for healthcare providers to have an auditing process in place to ensure that their claims are accurate. If you want to provide insurance companies with the correct information, you have to go through a thorough process to catch any errors before a claim is submitted for approval. This extensive process needs to be clearly defined and executed to prevent any delays in the revenue cycle. It is crucial for medical practices to realize that delays typically lead to a loss of revenue. Keep reading and discover a few tips for creating a successful medical billing audit process.
Develop a Strategy
Depending on the size of your practice, you will need to formulate a clear strategy for auditing the medical billing claims. Aspects to consider include the number of payers you work with, the number of billers and coders you have within your organization, and the number of payers you work with as well. A person within your organization should be responsible for conducting these audits and following through on a clear plan with randomly selected claims to see if it was processed correctly.
Determine Potential Risks
Identifying any risky trends from billing reports is critical. The way to do this is to compare performance throughout the year. It is important to run frequent reports to see how specific codes are being reimbursed. You want to ensure that payment terms are being followed, so you receive the payments that you are owed.
It is important to have goals throughout the year in regards to your practice’s medical billing. For example, your aim may be to lower your denied claims rate. Another step you should take is to continuously follow up with patients pay their rates in a timely manner. In some cases, you may need to tap a patient on the shoulder a few times before they respond. Also, members of your staff need to be trained to collect all of the necessary information in order for your practice to code correctly.
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