Your Healthcare Facility Needs a Medical Billing Audit

When was the last time you conducted a medical billing audit? Many healthcare facilities conduct these audits infrequently, making it difficult to accurately assess, identify, and correct inefficiencies, compliance risks, and cash flow issues. Learn about the benefits of medical billing audits and ways to get the most out of them.

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Often, the clinical and financial sides of a medical practice or healthcare facility work independently of each other, without fully understanding how the other side operates. Whereas clinical teams are responsible for delivering optimal patient care, the financial team is responsible for efficient, cost-effective operations, billing, and cash flow management to ensure continued patient care and staff support. Both teams are critical to the optimal function and patient care delivery within a medical facility. Regular audits are essential to the health of these teams and the facility, but what exactly does that mean?

What is a medical billing audit?

Unlike a clinical audit, which examines the medical procedures and practices that medical personnel provide for the purposes of preventing, diagnosing, and treating medical conditions, and determines whether that treatment was necessary and in accordance with medical standards, a medical billing audit is a systematic evaluation of healthcare administrative practices, including coding and billing processes. A complete medical billing audit can uncover inefficiencies, compliance risks, and opportunities to improve cash flow.

A medical billing audit looks closely at the efficiency of processes and practices. It checks the accuracy, reliability, and compliance of documentation and coding practices, and it identifies opportunities to regain lost revenue.

Did you know a medical billing audit can be either internal or external? An internal audit is performed by personnel within the organization and should be scheduled routinely to ensure the practice is operating efficiently and according with federal and state compliance regulations. It will also prepare the practice for an external audit, which is conducted by an objective third-party individual or organization.

Benefits of a medical billing audit

A medical billing audit provides critical insights into the financial and operational health of the facility. For example, a medical billing audit will help your team:

  • Uncover inefficient processes or poor practices to help boost your bottom line
  • Identify and reduce coding errors and costly claim denials
  • Proactively identify and fix errors before federal contractors request documents and discover deviations from national averages
  • Protect the facility against false claims of liability
  • Avoid costly fees and penalties, especially if services are provided through Medicare
  • Improve the overall patient experience.

Getting the most from a medical billing audit

It’s important to have a regular schedule for audits so you can recognize and address any problems before they become critical. To do so, first establish the scope of the medical billing audit and any personnel resources needed. Prioritize high-risk or problematic areas, and be sure to do your research to understand the laws and regulations that apply to the areas being audited. You'll want to establish benchmarks and compare performance with past audits to find any irregularities or persistent problem areas. Most importantly, do something with your results. Communicate with staff about areas of concern and inefficiencies, and share a plan for taking corrective action.

Although the term “audit” often carries a negative connotation and can cause anxiety and apprehension among your staff, the process and results are well worth the effort. Reassure the team the audit is not being done to punish anyone; rather, it’s intended to help the entire practice enahnce patient care, eliminate inefficiencies, and improve the bottom line.

To learn more about medical billing audits and key ways to improve your revenue cycle billing processes, visit us at TruBridge.