What is medical auditing? Do you feel a small spike in anxiety just by hearing the term? You got into behavioral health to help patients. You probably don’t start your day excited to wrestle with insurance companies and spend all of your time thinking about billing. Nevertheless, proper billing procedures and insurance claims management are essential to your ability to provide great service to your patients. Compliance with regulatory standards like those set out by The Health Insurance Portability and Accountability Act (HIPAA) is also key to your practice’s wellbeing and financial success.
At RevWerx, we’re here to help you prepare for and, when possible, avoid external medical billing audits altogether. We do this by offering comprehensive internal auditing and other services that ensure your billing process is legally compliant and running at peak efficiency. Call us today at 833.309.0138 or reach out online to ensure your practice’s billing department exceeds expectations.
What Is a Medical Billing Audit?
Medical billing audits are processes that review billing documents for accuracy and legal compliance. Auditors look at samples of the medical claims documentation your practice has submitted to insurance companies. A billing audit looks at several critical areas where your practice could be vulnerable if audited by the federal government or an insurance company:
- Problems with verification of patient eligibility for services they received
- Inappropriate or inaccurate adjustments made to payments
- Gaps in the patient medical information that is needed for proper claims processing
- Clinical coding errors: incorrectly documented procedures and services
Types of Medical Billing Audit
Medical billing audits come in two major forms, external and internal. Regular internal audits can significantly reduce the possible negative effects of external audits.
External Audits
External audits are conducted by either the federal government or large insurance companies. Government healthcare audits evaluate Medicare and Medicaid reimbursements and claims. Medicare audits are conducted by a third-party contractor or by federal employees. Medicaid audits are more frequently completed by contractors but might also be conducted by state government employees who have a detailed understanding of your state’s particular Medicaid laws.
Large commercial insurance providers like Blue Cross Blue Shield, United Healthcare, and Aetna also regularly audit healthcare providers. These audits often take place more frequently than government audits. The good news for providers is that you have increased say in how they take place. Where government audits focus on adherence to laws and regulations, insurer audits focus on claims reimbursements. In working with insurance companies, you may have the opportunity to create a customized contract. This contract relates to what classes of claims are audited and actions you can take following audits.
Internal Audits
Internal audits help your practice streamline its billing department and check for any issues with legal compliance and efficient processing. Your practice either conducts these audits itself or hires an outside company to conduct them.
After an internal audit, you can correct any problems the audit found before they become major compliance issues with the federal government or insurance companies. A streamlined revenue cycle with transparent billing procedures creates strong relationships between your practice and insurance companies.
Internal audits also benefit your practice by finding revenue leaks that cost your practice hundreds or thousands of dollars. They likewise help create optimal workflow and accountability within your practice.
Learn More About Getting a Medical Practice Audit by RevWerx
Medical billing audits don’t have to be intimidating. At RevWerx, we are focused on solutions. When we perform an internal audit, we not only identify problems but help you fix them. We’re also standing by with a host of services to strengthen your billing cycle, including claims management, in-house billing implementation, utilization reviewing, verification of benefits, and aging collections management. Reach out to the RevWerx team online today or call 833.309.0138.
