Superior medical claims performance

Medical billing audits provide an opportunity to improve claim performance by avoiding denials. In medical practices, the range of medical billing denials usually lies between 5-10%. Claim denials have a drastic effect on the cash flow of a healthcare business. The most common reasons leading to claim denials include inability to provide required pre-authorization, missing documentation, claim form errors in patient data or procedure codes, duplicate claim submission, claim submission after the deadline issued by the payer, medical procedure not considered as a necessity, ineligibility due to lack of coverage by the payer and use of out-of-network provider etc.

Timely audit can prevent most of the reasons that lead to denials by identifying and rectifying the potential problematic errors, thus contributing to the financial growth and success of a healthcare business.

Enhanced medical billing compliance

This is one of the strongest reasons why audits are crucial in order to streamline and standardize the medical billing and coding process. Medical billing and coding procedures must be in compliance with HIPAA (Health Insurance Portability and Accountability Act), otherwise a medical facility as well as their billing partner can face disastrous consequences and legal penalties tarnishing their reputation in addition to monetary losses. Some other acts and statutes that ensure healthcare compliance include FCA (False Claims Act), AKS (Anti Kick-back Statute) and Physician Self-Referral Law also known as Stark Law. Medical billing audits perform these spot checks for risk assessment. Moreover, they protect the medical practice against fraudulent billing activity and claims.

Streamlined workflow of medical practice

Audits set the standard for the office staff by implementing policies and procedures that creates a positive and stable work environment and culture of compliance which in turn attracts and retains talented employees. In addition to increased productivity, some other benefits of streamlining the workflow of medical practice as a result of audit done well is cost efficiency, improved communication and better time management.

Healthier payer-provider relationship

Payer-provider relationship holds as much significance as patient-physician relationship for the sustainability of a medical practice. The importance of forming a rewarding relationship with the payers lies in the fact that they are the ones who reimburse the claims. Medical billing audits lead to accurate claim submission. Lesser issues to debate over is something that is appreciated by the payers and it boosts the business relationship between the medical provider/billing agency and the payers/insurance companies.

Learning from the results of medical billing audit

Results of the medical billing audit must be used for educating the medical coders in order to prevent similar errors in future that can lose revenue for the medical practice. The outlook of the medical coding staff towards audits, both internal and external, should be improved by clarifying that audits should not be seen as something that discredits their work rather audits should be accepted in good spirit and seen as an opportunity to make progress in their work. Audits should be utilized to develop quality benchmarks for the coders and to offer them consistent and reliable resources for assistance.

At Avernus Medical Billing, we specialize in providing Medical Billing and Coding Services all over USA with the help of certified professionals who will ensure that your work is billed and charged, minimizing the risk of losing income and federal non-compliance.

For further queries, call us at +1 817-989-6949 or send us a mail at info@avernuscorp.com and we will be delighted to assist you.