Medical bill auditing can help health care provider identify bogus charges on hospital bills through the comparison of itemized bills against medical records, treatment settings, service codes, etc., and save significant amount of dollars of patients. This is the best way to improve your clinical documentation and the livelihood of your health care organization. Afterall, quality health care is based on accurate and complete clinical documentation in the medical record.
Industry Standards State
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Medical record audits are necessary to determine areas in your health care organization that require improvements and corrections. The Centres of Medicare & Medicaid Services (CMS) announced that up to one out of ten physicians and other healthcare professionals would have to undergo another round of payment audits.
As per the latest CMS update, around 5-10% of all eligible health-care professionals attesting for meaningful use will be selected for prepayment audits. These selections will be made randomly and it will be based on protocols identifying suspicious/anomalous attestation data. Moreover, post-payment audits will also another 5-10% of physicians and other healthcare professionals.
What is the need of medical auditing?
Medical auditing requires conducting internal/external reviews of coding accuracy, policies, and procedures to ensure that the practices run an efficient and hopefully liability-free operation. Medical-bill-audits are performed to:
- Determine faults in the billing documentation in the claims
- Protect against fraudulent claims billing activity
- Determine if there is a variation in billing from national averages due to inappropriate coding, insufficient documentation, or lost revenue
- Identify the problem areas while billing and make corrections in it before insurance or government payers challenge inappropriate coding
- Prevent governmental investigational auditors to question about inaccuracy in billing in your practice
- Prevent undercoding, bad unbundling procedures, and code overuse in the billing documentation
- Identify deficiencies in reimbursement procedures and rectify the process of reimbursement
- Prevent usage of outdated/incorrect codes for procedures
- Verify ICD-10-CM and electronic health record (EHR) meaningful use readiness
How can physicians prepare for an audit?
To prepare for an audit, practices should:
- Designate one person to regularly check that all responsible parties are complying with meaningful use attestation guidelines
- Keep a backup of all the data related to billing and documentation securely
- Look at the reports carefully before submitting it and check for false claims
- When selected for an audit, respond immediately to receive the bonus if physician passes audit review
- Retain supporting documentation (in either paper or electronic format) used in the completion of the Attestation Module responses for six years post-attestation
- Include documentation to support payment calculations to follow the current documentation retention processes
- Be prepared to capture dated screenshots (patient data with another clinician/other software function, etc.) and present them if auditor may request
MBC helps physicians get successfully get through an audit:
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Medicalbillersandcoders.com has been assisting in medical-bill-auditing for healthcare organizations for over a decade now across the 50 US States and across varied specialties. Our customized services along with a dedicated medical billers and coders assures regular, accurate and detailed medical record audits for our clients. Our team is constantly working to identify opportunities which help improve accuracy, compliance and productivity in the health care system.
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