Nearly every medical practice faces auditing from governmental agencies like the CMS. An equally important auditing process, however, is one that your medical practice takes on itself.
Medical Auditing Explained
The main reason to perform a medical audit is to improve the financial health of your medical practice. An audit evaluates medical codes selected for diagnosis and procedures to ensure that they are supported by documentation from the physician. Any weaknesses revealed identify training opportunities that can be applied to your medical team
Second reason for medical practice owners and administrators to perform an audit is to make sure deliver the highest quality health care to patients, your medical team must rely on patient health records. Ensuring that this documentation is complete, accurate and clear is the purpose of engaging in a medical audit. It serves to highlight those areas that need to be corrected and/or improved.
Benefit to Perform a Medical Audit
At its core, medical auditing means conducting a review of the procedures that your medical practice follows. This could be an internal review by someone on your team, an outside agency or both. For the most thorough assessment, it's necessary to perform both an internal and external audit. Doing so sets your healthcare organization up for operations in an efficient and compliant manner.
1. Identify deficiencies in reimbursement and present opportunities for additional reimbursement, if appropriate
2. Highlight variations from the national average because of correctable issues such as incomplete documentation, erroneous coding and/or lost profits
3. Target and identify outliers and potential errors before outside payers can discover them and request an additional audit
4. Identify and address any issues and problems that exist within coding prior to governmental agencies and insurance companies can challenge the figures
5. Identify and halt the outdated use of procedural coding
6. Offer protection against billing activity and claims that are fraudulent
7. Verify readiness for electronic health records and ICD-10-CM meaningful use parameters
8. Bill for procedures that are documented by identifying the overuse of codes, inappropriate unbundling and under coding
Medical Auditing: a Crucial Element of Successful Medical Practices
Auditing is part of running a medical practice in today's results-oriented landscape. In order to guard against compliance issues that could put you on the radar of governmental agencies and insurance companies, it's better to adopt a proactive approach to medical auditing. Working with various insurance companies and agencies such as CMS requires that you stay updated on the latest changes. This is best done with regular medical audits.
While ensuring compliance with both government regulations and insurance requirements is important so your medical practice stays on the right side of the law and gets reimbursed for its services, this is only one reason for undergoing regular medical audits.
In these days of medical practices that are being asked to do more with less, finding gaps in your processes and procedures requires an objective examination that's unclouded by any motives or goals connected to you. With an eye to streamlining productivity and identifying those areas where additional training and/or resources could be devoted, medical auditing can be a welcome addition to your medical practice.
Finding a Medical Auditor
Once you've decided to undergo a medical audit, the question becomes should this process be assigned to an internal employee or should a third-party company be brought on board. Ideally, internal audits should be completed on a regular basis -- perhaps once per quarter. At the very least, your practice should be internally audited at least once a year. If systemic issues are uncovered during that time, it might be wise to contract with a third-party company.
Ensuring that your back office is free of any billing and/or coding issues is a primary reason for undertaking a medical audit. Be proactive about addressing any potential issues by turning to M-Scribe Medical Billing Services. As a national leader in medical claims auditing, coding and billing, we partner with you to analyze and address the needs of your medical practice. Contact us today at 770-666-0470 or email us at Patrick.Dougherty@m-scribe.com