Medical Billing and Coding
Beginning with a baseline audit will bring success to your practice.
Would you pass an audit in case a payer auditor showed up at your practice door? You must be using internal chart reviews to assess your practice's compliance and medical billing processes -- before someone else does.
Gain from Internal Review
Carrying out internal audits can help you safeguard medical billing and coding compliance and might also help you get money you've been leaving on the table. Finding problems early helps ease risk.
Audits will also expose discrepancies in documentation and coding so you can focus your staff education. For instance, maybe something conveyed was misunderstood, or confusing, and that will come out in the audit.
Medical Billing Tip: Refer to these internal audits as "reviews" to make certain that employees don't hear the word "audit" and panic. Few people equate an "audit" with finding mistakes; however "reviews" are taken as check-ups of your coding practices.
Begin With a Baseline Evaluation
You must begin your audit efforts by carrying out a baseline audit -- the first comprehensive audit your practice undergoes. Then you can choose how often you will carry out internal audits each year.
Why? With the information garnered from a baseline audit, you'll be able to ease future auditing efforts and concentrate on the most significant areas to your insurers. Your goal is to get every provider and biller as nearly 100 percent compliance and accuracy as possible.
Follow a Checklist
Your first step in the auditing procedure is to slim down the parameters of your audit. You must answer the following questions before you get started to ensure accurate medical billing:
Would you pass an audit in case a payer auditor showed up at your practice door? You must be using internal chart reviews to assess your practice's compliance and medical billing processes -- before someone else does.
Gain from Internal Review
Carrying out internal audits can help you safeguard medical billing and coding compliance and might also help you get money you've been leaving on the table. Finding problems early helps ease risk.
Audits will also expose discrepancies in documentation and coding so you can focus your staff education. For instance, maybe something conveyed was misunderstood, or confusing, and that will come out in the audit.
Medical Billing Tip: Refer to these internal audits as "reviews" to make certain that employees don't hear the word "audit" and panic. Few people equate an "audit" with finding mistakes; however "reviews" are taken as check-ups of your coding practices.
Begin With a Baseline Evaluation
You must begin your audit efforts by carrying out a baseline audit -- the first comprehensive audit your practice undergoes. Then you can choose how often you will carry out internal audits each year.
Why? With the information garnered from a baseline audit, you'll be able to ease future auditing efforts and concentrate on the most significant areas to your insurers. Your goal is to get every provider and biller as nearly 100 percent compliance and accuracy as possible.
Follow a Checklist
Your first step in the auditing procedure is to slim down the parameters of your audit. You must answer the following questions before you get started to ensure accurate medical billing:
- What is the focus of the audit? You are required to know exactly what you want to achieve.
- What will be the audit's scope? Reflect on which providers, services, date ranges, and payers your audit will address. Look at areas for instance incident-to billing, modifier use, as well as code edit unbundling.
- How will you choose charts? Will you define this process for each provider, or will you randomize the chart selection? You must select a minimum of 20 charts per provider for your review. That chart selection must include a range of types of services, involving E/M services, consultations, hospital services, and surgical procedures.
- What documentation will you evaluate? Pull charts and organize supporting documentation, for instance a printout of physician notes, account billing history, CMS-1500 forms, and clarifications of benefits (EOBs) to assess during your audit. In case your practice is doing everything as per what the payers need, the next step is to define whether you have supporting documentation.
- Why am I finding denials? All through an audit, or even in a separate billing review, you must be reviewing denials. In case your review shows that your medical billing practices are perfect but claims are still being denied, you need to examine.
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