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presentation

Billing Audits for Physician Groups

April 05, 2016



Accurate and complete clinical documentation is required for providing quality healthcare. The best way to improve documentation is conducting regular medical audits.

Due to budgetary constraints at federal and state levels of government, new initiatives have been introduced to audit the billing and coding practices of healthcare practices and to demand monetary refunds, where applicable.

Industry Trivia

Medicare RACs are expected to initiate more Medicare claims audits and perform increased unscheduled onsite visits to solo and group practices in near future
According to Medical Billing Advocates of America, errors are found in at least eight out of 10 medical bills, costing money to patients and insurance companies
Misinformed and ill-educated third party payers are considered the source of many errors in group practices
An average practice can lose up to $50,000 a year due to under-coding

Group practices need to conduct periodic independent audits of their billing processes. They need to ensure that their coders and billing experts receive certified and specific training. Billing and claims operation systems also need to be reviewed along with adoption of effective procedures for claims submission.

  • It is necessary to ensure that all physician services are being documented in a proper manner
  • Each claim should reflect the services accurately and only properly documented service claims should be submitted. Documentation of submitted claims should be available for audit
  • Group practices should maintain the integrity of medical records and documentation
  • They should consider the use of perforated forms that include prompts for required information. This will allow easy and accurate internal billing audits

It is important for the billing and coding department in a group practice to keep current with coding and billing changes. For instance, over-coding should be avoided because it will expose the practice to external audits or even charges of Medicare fraud.

Medical billing and coding services need sprucing up because errors in billing are considered fraudulent billing in case of Medicare/Medicaid audits. In this scenario, the practice will have to reimburse the insurance companies an additional paid amount that will eventually put their revenue cycle at risk. So, in order to avoid such risks, streamlining of medical billing services becomes a necessity. From accurate application of ICD-10 codes and transparency in billing to periodic reviewing of billing stages, there are several ways through which physician groups can avoid an audit.


MBC's Role in Helping Physician Groups in Billing Audits

Professional auditors mainly look for errors in the way practices file claims and pursue collections. As a leading provider of billing services, MBC has been assisting many physician groups across the country in billing audits through top-notch billing and RCM solutions. The company has a team of certified and experienced coders and billers who are experts at error-free coding and timely claims submission. They help practices maximize revenue by regularly conducting internal audits.

 

Category : Practice Administration