In medical billing management, there can be so many nightmares mainly because the opinions you have given above can go wrong in many ways by leading to loss or revenue issues and or compliance issues. That is why we offer Medical Billing Audit Services, to set up the process, as well as to monitor and enhance it in a timely manner.
What Is a Medical Billing Audit?
A medical billing audit is an explicit assessment of your billing and coding processes. Its purpose is to check legal compliance or to look for inconsistencies in your processes and where you can clarify them or correct them. We just use our audits as a means of doing different essential tasks, such as the validation of patient details as well as diagnosis code scrutiny.
Why Are Medical Billing Audits Essential?
- Stay Compliant: Meet all regulations, including CMS, HIPAA, and payer policies.
- Protect Your Revenue: Catch errors like duplicate or underbilled claims to avoid financial loss.
- Find Hidden Errors: Spot issues like upcoding, undercoding, or missing information before they become costly mistakes.
- Lower Risks: Avoid insurance audits, fines, and penalties by staying ahead of compliance issues.
- Better Documentation: Ensure your records justify the treatments and services provided, building trust with patients and payers.
Key Areas We Focus On
- Code Reviews: Are your CPT and ICD-10 codes accurate?
- Medical Necessity Checks: Do you know if your claims show why treatments were necessary?
- Compliance Standards: Are you following state, federal, and payer guidelines?
- Claims Accuracy: Is all patient information and billing data correct?
- Denial Analysis: What’s causing claim denials, and how can you prevent them?
Common Errors We Help Fix
- Upcoding: Charging for higher-level services than provided.
- Undercoding: Missing charges for services rendered.
- Duplicate Billing: Submitting the same claim twice.
- Incomplete Documentation: Failing to justify treatments.
How We Support You
- Thorough Reviews: We dive deep into your records to catch every issue.
- Tailored Solutions: Get advice specific to your practice’s needs.
- Training: We teach your team how to avoid future errors.