11/19/2022
Internal Medical Billing Audit – Goals and Method
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Conducting internal audits has become crucial to assess if all these processes are working well, reduce the risk of errors, and ensure compliance in revenue cycle management (RCM). According to the Medical Group Management Association (MGMA), internal audits can:
Identify errors in provider documentation.
Identify inefficiencies in payer reimbursement.
Determine the usage of incorrect medical codes, such as the use of deleted or modified codes.
Uncover areas of payer rules if a medical practice is billed inappropriately.
Identify errors in claim scrubbers or claims software deficiencies utilized by the medical practice.
Determine under-coding, overcoming, unbundling, and lack of modifier usage.
Coding accuracy, appropriateness of documentation, and completeness of a claim will be verified by evaluating the following:
Whether the CPT code accurately reflects the service performed or whether another code would be more appropriate.
If the patient’s chart documentation supports the billed service.
Identify claims not accurately processed by the payer.
Benefits of Internal Medical Billing and Coding Audits
Internal audits promote revenue cycle management success by helping to:
· Identify erroneous billing practices that lead to financial losses
· Identify and correct coding errors before they come under government or insurance-payer scrutiny
· Reduce claim denials caused by insufficient documentation or coding errors such as the use of deleted or modified codes
· Ensure proper documentation of procedures and services reported
· Correct variations from national averages due to inappropriate coding
· Promote adherence to coding protocols
· Defend against RAC audits or requests for medical record
· Documentation from federal contractors and malpractice litigation
· Identify gaps in revenue
· Drive timely claims payment and coordination of benefits
· Optimize RCM
Get Expert Support from https://mdzoneglobalsolutions.com/
With thousands of ICD-10 and CPT codes, only trained auditors who have expertise in coding can catch their inappropriate use.
Please contact us for further assistance.
Phone: (877) 210-1107
info@mdzoneglobalsolutions.com
https://mdzoneglobalsolutions.com/
