Your medical practice needs to be ready for a medical billing audit at all times, and that means you need to understand how the audit process works. This can be easier said than done because there is no universal way to review medical coding and billing for a medical practice. Fortunately, there are a few steps that are foundational for pretty much any practice. Keep reading to learn about four basic steps that go into the medical billing audit process.
Find Out the Scope of the Audit
You could be dealing with many kinds of audits, such as comprehensive, hybrid, and random audits. The approach you take depends on which one you’re handling at the time.
For random audits, big and small claims are chosen randomly depending on their various dollar amounts. Comprehensive audits perform thorough inspections of the audited claims, emphasizing the importance of getting refunds. Hybrid audits mix the other two audits together, scrutinizing samples of all claims to see if there are any gaps.
Determine a Time Period to Gather Samples for Auditing
When determining how many claims should be in your sample, you should select a number based on how many physicians your medical practice has. You also must select the right time to pull these samples in for auditing. Typically, the best time will be weekly, monthly, quarterly, or after one financial year.
Identify Points of Concern
Take a look at your billing reports and see if you notice any bad trends or other problem areas. Reports get compared with previous performances either monthly or annually. The way that CPT codes that get used by staff and providers are scrutinized to determine if client encounters are getting coded correctly, and if coding patterns are any different from the industry average. There is a benchmarking procedure used in the medical billing audit to get these tasks done. By observing the billing reports, it can be determined whether or not patient encounters get coded the right way, and if your practice’s billing procedures are working properly.
Take Action to Correct Problem Areas
When you’re done with your medical billing audit, and you’ve figured out where problem areas lie, you can take the needed measures to address those problems. Whether the solution is more staff training or new strategies to make your billing procedures better, you’ll see to it that the same problems you discovered before don’t happen again.
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