Medical coding and billing is a sensitive and integral segment of healthcare service provision. Errors in billing and coding create mistrust and lead to unending disputes. Patients feel cheated when they're billed incorrectly, and this could cut short long-established professional relationships. Medical coding and billing must be error-free and compliant to maximize profits and build trust. Errors are bound to happen, but medical billing auditing and other mitigation strategies can minimize the adverse impact.
A medical coding audit is an annual or quarterly inspection of the medical billing processes. It involves a thorough review and valuation of the quality and integrity of medical documents. Conducted by a third-party or internal team of auditors, the exercise evaluates health records upheld by medical practice. Medical billing auditing digs deep into the medical billing data presented to payers to reveal errors and pinpoint areas needing improvement. Although it is a routine healthcare practice, certain events could trigger sudden medical coding audits. These include unending payer complaints, missing documents, and increased denial rates.
Whether an internal or outsourced billing audit, it covers a range of issues relevant to medical billing and coding. The auditing process involves:
Preparing for a medical billing audit is integral to improving the quality of results. Different medical coding auditors follow different criteria, but the following checklist makes the process more detailed.
Hospital billing auditors have access to various forms, which is essential for optimizing the auditing process. The claim review form contains claim documentation information as reviewed by the auditor. The discrepancy finding form documents all the data about discrepancies and errors unearthed by the auditor in the claim documentation.
Finally, the corrective action plan form contains the data outlining the plan of the healthcare provider to address the discrepancies and errors.
Every healthcare provider wants to remain compliant with payer regulations without overbilling or underbilling patients. They want to create an environment that supports financial growth while reducing fraud. That is what medical billing audits do. They are efficient tools for helping you maximize the profits from your healthcare facility and build lasting relationships with patients.
For the overall efficiency of billing audits, you have to bring Adonis into the picture. This revenue intelligence platform automates and streamlines your medical billing auditing process. It utilizes artificial intelligence and machine learning to detect and correct errors in your billing records to improve your facility's financial performance.
