A medical billing audit is able to reveal hidden errors embedded within a medical record. It’s important to include these errors inside of your audit to make sure that patients are being charged properly, while also receiving optimal medical care. Here are some of the errors you should include in your medical billing audit.
Duplicate Submissions of Claims
Claims will get denied very frequently as a result of the claim having already been processed earlier. If a provider refiles a claim in an attempt to “fix” it, but the claim was already submitted prior, the second claim will be seen as a duplicate.
Services That Are Not Covered
A medical billing audit will also be needed whenever services that aren’t covered by the payer are billed to the patient. This is an error that’s found both in external and internal billing audits. It’s important to check with payers frequently to be sure you understand all of the most current exclusion policies.
Medical Necessity Isn’t Established
This is a problem that can occur whenever a payer doesn’t consider billed services as medically necessary. It’s important for the auditor to check carriers’ lists of covered diagnoses for the specified services that are mentioned in the audit.
Improper Unbundling of Medical Services
Different medical services have different codes, so the codes you include in your medical billing audit should accurately reflect the services that were provided. Sometimes, medical coders and providers may include multiple codes in an audit, even if there is a single code that would cover all services. This is what’s known as unbundling, and you’ll want to avoid it whenever possible. That’s why it’s important to be up-to-date on different medical codes so you know when multiple ones are needed versus when a single code can be used.
Wrong Diagnosis
It’s important to include the proper diagnosis in your medical billing audit. Services that don’t have the right diagnosis are going to get denied. This is because the diagnosis that’s given will be listed as primary, even though the covered diagnosis that was used during medical procedures was completely different.
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