Steps to Conduct a Successful Medical Billing Audit Process

Healthcare providers must perform medical billing audits process to confirm they follow the rules and attach them to their budgets. Audits are designed to find mistakes, flaws, and possible income leaks that can improve the revenue cycle overall. By doing careful checks, practices can see errors in the code that lead to more payment and less lost income. Fines and penalties are less likely to happen when there are audits. Medical audits checklist also help to follow the complex rules of the healthcare industry.

Auditors help practices improve processes, lower costs, and maximize their cash flow by identifying areas for improvement. A medical billing audit usually examines different parts of the income cycle in detail. Thus, the auditor must gather the correct information, review the paperwork, find mistakes, and plan to fix them. The audit process can be thorough and valuable if practices follow an organized method.

Let us explain the main steps needed for a successful medical billing check. 

1. Set The Goals And Scope Of The Audit

A critical aspect of an excellent medical billing audit is a clear audit scope and goals. A successful and beneficial audit is possible if you are clear about what needs you are looking for and what goals must be. It would be best to do some things before starting the medical billing check. What kind of audit will depend on how big and complex your practice is. Large healthcare practices require an audit that covers all relevant areas.  

When your practice goes through big changes, like getting a new EHR system or hiring more people, the audit may only look at a minor part. It can help you discover new rules or regulations affecting your billing. If parts of your billing worry you, you should focus the audit on those parts. It’s essential to set clear audit goals after deciding on the scope. These goals must align with your primary goals of improving the revenue cycle management and providing compliance.

Goals that can come from a Medical Billing Audit Process:

• Find mistakes in the code to make more money.
• Remember to follow the rules.
• You can save time and money by changing the way you bill.
• Use your billing to its highest potential.
• Stay safe from scams in your practice.
• Make more money from your business.

2. Get the Data You Need, Get Complete and Accurate Information

A medical billing check must have a strong, correct, and complete database. It needs to have information about each patient, data from EHRs and pricing tools, and records of insurance payments. It is important to use the proper methods and check the data you collect.

You can be more sure that the data you collect is correct if you compare it to data from other sources and use tools to speed up the process. Also, follow HIPAA rules and keep information safe when collecting data and doing studies. 

3. Set Standards For Evaluation And Create Audit Criteria

Setting clear, objective standards for review is vital for ensuring that the audit is thorough and valuable. These standards should align with best business practices, government rules, and your healthcare facility’s unique needs. By developing clear standards, you can check the accuracy and compliance of billing methods.

When developing audit criteria, consider factors such as Adherence to ICD-10 and CPT coding rules, compliance with Medicare, Medicaid, and private payer rules, and sufficient medical documentation to support billing codes alignment with your organization’s specific guidelines.

4. Review Claims Thoroughly And Identify Any Errors.

After deciding what the audit will cover, collecting the needed information, and setting the guidelines for the audit, you can start the audit. In this step, you check the claims to ensure they are correct and complete and follow the code rules. Keep some things in mind during the audit. Look over a list of claims to confirm they are complete and correct. Assure the ICD-10 and CPT numbers used in the forms are accurate. Guarantee that the amounts you pay out meet the amounts you hope to get back and that enough medical records back up payment numbers.

5. Make Plans For Progress And Corrective Steps

Create specific corrective step plans to manage the problems found in the audit. These plans should include detailed steps, due dates, and who is responsible. Consider the most important things to deal with first, such as checking whether the provided methods are helpful and affordable. Check how possible corrective actions might affect money made, rules followed, and patient happiness. It would be best if you made thorough plans for what to do next to fix the problems you’ve found and improve your bills.

6. Take Genuine Steps to Fix The Errors

Once you have made corrective plans, it would be best to carry them out. Staff members may need more training, internal processes may need to be updated, or the company may need to buy new technology. Corrective actions can significantly change how you bill and lower the chance of making mistakes again. 

7. Follow up and Monitor for Ongoing Compliance 

It is important to do follow-up checks to see how well they worked and find any problems that keep happening. Set up ongoing tracking processes to assure compliance and stop errors from happening again.

For follow-up and monitoring, here are some crucial considerations

• Plan regular checks to see how well corrective steps work.
• Keep up with the correct data to see how things are going and spot trends.
• Give your team regular training to stay updated on billing rules and best practices.