Medical Billing Cycle Tips to Avoid Billing Audits from Payer Sources

Medical Billing Cycle Tips to Avoid Billing Audits from Payer Sources

The medical billing cycle is the single most important aspect of any medical practice, as it controls the flow of finances to and from the practice. Not only is a smoothly operating billing cycle important from a financial standpoint, it is also necessary to avoid billing audits from payer sources, such as Medicare. Through integrity programs, payer sources look into billing cycles and codes for potential error. These payer sources hire contractors to conduct audits, and the audits are never random. Fortunately, these tips can help anyone avoid an audit.

medical billing cycle chartUse Caution with Templates

A busy medical practice often uses templates to save time during patient intake. While there is nothing wrong with using a template for efficiency purposes, documentation should always be patient specific. Billing audit contractors compare the documentation from one patient to the next to look for similarities beyond the format. If doctors or nurses use a lot of the same wording across patients’ documentation, this sends a red flag to the contractors.

Extra Eyes

It is in the best interest of a clinic to have a certified professional coder examine documentation for accurate coding, as well as potential errors. There are individuals who audit medical records for a living to catch problems before payer sources – such as Medicare – do. Consider this an investment in the continued success of the practice and hire the extra pair of eyes to conduct in-house audits.

Document Necessity

When ordering a test or procedure, take the time to document why it was necessary. MRIs, outpatient physical therapy, and sleep studies are three examples of procedures many pay sources believe medical professionals order more often than necessary. Use extra details and explain why these tests and procedures are necessary.

Diligent Staff Members

Mindful and diligent medical staff members who slow down and avoid rushing through paperwork are less likely to make a mistake that triggers an audit. Take the time to train staff members to understand what audits are and how they can cause a problem. Then, take the time to walk staff members through what the payer sources’ contractors look for as potential triggers for an audit. Obviously, it is also necessary for all medical staff members to understand how to properly code all medical records. Retrain staff members to brush up on coding from time to time.

Check Payers’ Websites for Audit Sheets

In some cases, payer sources include an example of an audit sheet on their website. This audit sheet includes what the payer source checks during an audit. Consider downloading a copy of the audit sheet and conduct internal audits from time to time. It is far better for a medical practice owner to find and fix problems before the contractor does.

It is a common misconception that audits are random. With a proper billing cycle, internal audits, and diligent, well-trained staff members, a medical practice owner can avoid audits from payer sources completely. After all, the last thing a payer source wants is to pay for an audit if the audit might not yield any results.

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