A well-functioning medical facility will have an easy time collecting reimbursements from patients, all while seeing very few denials. Even so, however, there’s still another important step that medical practices should follow. This step is to conduct medical billing audits. If you aren’t conducting these audits, there’s still money that your medical practice is leaving on the table, preventing your practice from operating as efficiently as possible. In order to carry out a successful medical billing audit, here is what you’ll need to do.
Determine the Scope of the Medical Billing Audit
It’s important to know the scope of your medical billing audit so you know how many people are needed to get it done. You might need to look at the number of payers with whom you work, the number of coders and billers in your practice, and how many providers your practice has. It’s also a good idea to plan out your audit tactics. Oftentimes, you’ll want to randomly select a certain number of charts from each provider and look at the documentation, as well as what got filled out.
Assess the Situation
Look over your billing reports, and keep track of problematic trends or areas of high risk. You’ll want to review current reports with the reports that have been conducted in the past to see how often irregularities happen.
It’s also good to look at how often physician services are provided over time, and compare this frequency with other physicians. You should run reports on how CPT codes get reimbursed, and compare contract terms with your individual payers. This lets you know whether or not your practice is being paid the correct amount.
Make Changes, as Needed
Once you’ve identified areas of concern, set up goals that can help your medical practice reduce the number of denied claims it gets. Make an effort to convince payers to pay their rates accurately and on time, and put together a follow-up plan for payers who frequently don’t get their bills paid in a timely manner. It’s also a smart idea to provide training sessions for your staff in order to improve any potential weak areas in the audit process.
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