Your Trusted Partner For Billing & Coding Compliance
Crucial elements of a practice’s compliance program include auditing and monitoring. There are many benefits to taking a closer look at your service lines. For instance, a comprehensive review of your organization’s coding and billing practices invites the opportunity to quickly identify and remedy any potential compliance issues. These steps should be taken so any scrutiny in the future can be easily handled. Additionally, a good audit can uncover unrealized coding opportunities and maximize revenue at the practice.
A billing and coding audit is a comprehensive review of a medical service encounter compared to what was submitted for reimbursement to either a government or commercial insurance payor. This systematic review is conducted to ensure accuracy, compliance with Federal and state regulations, as well as coding guidelines to confirm appropriate reimbursement. It also provides an opportunity to readily identify compliance risks, catch any potential occurrences of fraud, waste, and abuse and make swift corrective actions. Audits are also chances for making improvements in clinical documentation; updating outdated Electronic Medical Record (EMR) systems; or conducting safer operational procedures.
Did you know that while billing and coding audits should be performed at regular intervals as part of an entity’s compliance program, audits can also be performed for other objectives such as for due diligence in a potential merger or acquisition? It’s also important to conduct billing and coding audits when you employ a third-party billing company. Do not place your business at risk by skipping this crucial step. While it is good idea to perform your own routine internal audits, it is recommended you seek external assistance, get an objective partner who can conduct an analysis to better safeguard the practice from risk.
Billing & Coding Audit Process
The process of conducting a billing and coding audit is phased to ensure a complete look at the services provided. In general, an audit consists of a review of the following:
A review of the medical record documentation to verify that the services billed were provided and documented appropriately.
An assessment of the reimbursement codes assigned to services, procedures and diagnoses to ensure alignment with the patient’s condition and care provided.
Assurance that billing adheres to guidelines by coding bodies and regulations set by government and private insurers
The audit process identifies areas where risks like overbilling and underbilling exists and shows the ways to rectify them. It also provides an opportunity to discuss any discrepancies or areas for process improvement along with education. Feedback provided because of an audit can result in a noticeable improvement in accuracy and efficiency.
- Quality Assurance: Conducting audits confirms that documentation and coordinating billing and coding are compliant with regulatory standards
- Identified Areas of Improvement: Through the audit process, patterns or trends that indicate an opportunity for improvement can be identified
- Risk Management: Audits help address any potential legal or financial risk exposure for an organization. This proactive approach reduces any likelihood of regulatory scrutiny.
- Reimbursement Optimization: Thorough and accurate documentation provides maximum reimbursements and can reduce the amount of denied claims and potential requests for repayments.
- Collaboration: The audit process can provide opportunities for further education to occur for all staff members. The education process can fuel collaboration, sharing of insights and fostering a culture of learning and improvement within the practice.
- Enhanced Patient Care: Ultimately, by maintaining compliance, healthcare practitioners can focus on making more informed decisions and in turn, providing a higher standard of care for their patients.
Partner with Safe Harbor Group to Ensure Accuracy in Your Billing & Coding
As a healthcare provider, you need a partner you can trust who understands the complex arena of regulatory compliance. Our team consists of knowledgeable and experienced healthcare professionals that can provide practices of any size with the compliance assistance needed to allow you to focus on providing optimal patient care
