How to Develop Medical and Billing Practices to Avoid an Audit?


Medical Billing ServicesMedical billing services is a nuance that has to be handled carefully to ensure financial viability and sustained profitability of your medical practice. However, most medical practitioners lack the talent and knack for ensuring administrative checks that can develop an audit-proof medical billing practice. More often than not, medical practices attract medical audits due to either customer complaints or insurance carriers repeated rejection of claims. Various reasons which attract medical audits are –

  • Selection of incorrect code categories at the time of medical billing
  • Lack of pre-authorization at the time of patient walk-in leading to a claim rejection ratio of greater than 30% for medical practice
  • Providing service to all patients at one level and billing them for services at a higher level
  • Ignoring CPT and ICD 10 coding changes and failing to adopt them in your medical billing system
  • By default cloning of codes in EMR causing billing errors
  • Bundling of services being billed un-clearly and facing claim rejections
  • Customer complains regarding insufficient service levels or non acceptance of fee-for-value billing standards

In order to develop your medical billing practice that is audit resistant you must invest time in careful planning and continual monitoring of processes. Medical audits are always unwelcome as they not only disrupt the functioning of your clinic but also increase audit expense exponentially. Auditors invariably object to your billing records and reduce your Medicare and Medicaid reimbursements for future claims. Medical practices that can help your avoid the hassles and exorbitant costs ingrained in an unwanted medical audit are –

  • Training medical staff on usage of EMR – Electronic Medical Records have added value to many medical practices and continue to make medical process more and more effective. Adoption of EMR in your medical practice can only be shown effectively if your medical staff is well versed in using electronic data capturing and transferring
  • Compliance to HIPAA – Government regulatory norms are becoming more and more stringent when it comes to healthcare patient records. Data recording, data storage and data transfer have become highly sensitive areas which if ignored can cause repeated medical process audits. HIPAA compliance must therefore be regularly ensured in your billing practices.
  • Revenue Cycle ManagementRCM ensures homogenization of your payers mix and striving to achieve higher profitability from your current payers mix. Medicare and Medicaid reimbursement ratios are likely to become bleaker if your practice fails to show effective utilization of EMR in the coming years. Additionally, audits also address the issue of over-reimbursement and cost your practice in terms of long term and short term revenue. Ensuring a payers mix that is less dependent on a particular type of insurance carrier or individual payers can improve your billing efficiency as well as reduce error rate. is a medical billing services provider that installs medical billing practices that can reduce the risk of audit for your practice. At the same, healthy billing practices also ensure sustained profitability for your clinic in both short term and long term.

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