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Tips to Promote Success in Your Healthcare Claims Audit

Tips to Promote Success in Your Healthcare Claims Audit
Here are ways to become more successful in your healthcare claims audit.

Coding, billing, and compliance audits are not to be taken lightly; they play a vital role in uncovering areas that prevent compliance in your claims submissions, and your revenue generation can also be impacted. That’s why you need to maximize how efficient you are when you’re submitting audits. Here are ways to become more successful in your healthcare claims audit.

Establish a Compliance Plan

Any auditing process you make will start with constructing a compliance plan. You’ll want to have a provision embedded into this plan to account for the monitoring and auditing of billing and coding. After that, be sure that the audit routine you have is appropriate for what your compliance plan needs. Payers will question your billing and compliance practices if you don’t abide by your compliance plan. In some cases, you may even have to worry about fraud concerns.

Pick Between Prospective and Retrospective

Another part of your healthcare claims audit includes knowing how you’ll look at codes, charges, and documentation and when you’ll look at all of these. To do this, there are two decisions to be made. The first decision is whether you do prospective or retrospective audits, and the second is whether you use external or internal auditors.

Prospective audits are recommended whenever you want claims reviewed before they are submitted, while retrospective audits are done after claims are sent out.

Compare External and Internal Options

When getting a healthcare claims audit done, you also want to determine if you’re outsourcing audits to a third-party company or handling everything in-house. Remember that audits require specialized training to carry out properly, so if you don’t have anyone in-house with that level of experience, it will be best to bring in help from a trained professional.

Speak With Your Staff and Practitioners

Before starting audits, ensure all stakeholders are aware and on board. Let everyone know why an audit will be good for their practice. There may be some people who aren’t keen on participating. Still, you want to let them know that an audit will be good in the long term because they keep coders and providers safe against non-compliance, and your facility can avoid losing extra revenue.

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This entry was posted on Friday, June 23rd, 2023 at 3:46 pm. Both comments and pings are currently closed.