Medical billing audit is the methodical process of looking at and assessing the efficacy, accuracy, and compliance of all billing processes. Thus, an audit of the entire medical billing process will help a practice have a superior revenue cycle management system in place, which will help to maintain a healthy bottom line.

By definition, billing audits are more thorough than coding audits. They thus cover every stage of the revenue cycle, from the eligibility verification process to the denial management processes. All clinical records, financial records, and documents pertaining to policy that have been reviewed by payers or the government may be subject to audit.

The scope of medical care, medical necessity, pricing of services, and physician services are not covered by medical billing audit. Other qualified personnel review these areas.

The Audit Methodology

The following steps make up the medical billing audit process:

1. The audit's scope and the resources required to effectively and efficiently complete it will be decided by the audit team. In order to achieve the best results, the audit may look at the clinical staff members' work, payer combinations, and the makeup of the billing and coding staff.

2. Examining the practice as a whole to identify high-risk areas. As a result, the audit may also include a review of the provider services' frequency. Analysis of the billing staff's CPT code usage is also done.

3. Practices should implement corrective measures in response to audit findings for audits to be effective and meaningful. By establishing goals for improvement, these findings should be used as strategic information to improve revenue cycle management and care outcomes. Any areas where payers have been found wanting may be asked to improve.

Optimal procedures for efficient audits

Setting up best practices for billing audits makes sure that they produce the best outcomes for improving the healthcare revenue cycle.

• Perform quarterly audits with an experienced individual leading the audit team.
• Be proactive, especially with respect to adhering to payer guidelines.
• Keep lines of dialogue open between coders and providers.
• Watch the days in AR and the information from the monthly reports to identify trends as soon as possible.
• Think about monitoring increases in net collection percentage
• Make a system that tracks each patient's revenue cycle from the initial appointment to the final payment.
• Concentrate on the areas with the greatest potential for return on investment.
• Compare patient interactions with appointments.
• Compare CPT reimbursements to individual payer contracts to look for underpayments.
• Verify that no claim has been completely written off.
• Establish a procedure for handling claims that are rejected or paid incorrectly.
• Be proactive and supportive of internal audits. Think about routinely undergoing external audits
• Pay close attention to the small print, such as primary diagnosis and medication reports, as well as expensive costs.

Benefits of Internal Audit

Internal audits are always a financial investment for any organization. The following are a few benefits of performing medical billing audits:

(I) Better coding accuracy using the most recent recommendations

(ii) Identifying potentially troublesome areas or procedures

(iii) Enhanced billing system dependability and openness

(iv) The practice's workflow is efficient and seamless.

(v) Improvement of relations between payers and medical practices