August 8, 2022

5 Reasons for Medical Coding and Billing Audit

Recent research conducted by the office of the Inspector General for Health and Human Services found that 40% of Medicare E/M services lacked accurate medical coding practices. Errors in medical coding will directly affect medical billing which, in turn will impact the revenue of healthcare and urgent care centers. Healthcare services can experience punitive damages including loss of reputation and financial penalties.

Healthcare services need to find ways to curb the effects of misappropriating medical billing by performing timely and regular medical audits. This blog talks about how medical coding and billing audits can safeguard the interests of healthcare services and strengthen revenue life cycle management for claims.

1. Billing Audits Help in Identifying Coding Errors

Accuracy of medical codes play a significant role in smoothening the billing process and flow of insurance claims. Errors in manual coding will affect the quality of in-house coding services. When coding errors aren’t frequently deduced, it will lead to significant revenue leakage. Having an organized medical billing audit can effectively evaluate the effectiveness of clinical documentation. A billing audit highlights one-time and recurring medical coding issues that can complicate the claims on compliance grounds.

Medical coding errors are highlighted immediately when conducting billing audits. These errors arise when medical coders are not well versed with the latest coding guidelines and follow outdated guidelines. Automating medical coding and billing audits using software improves coding accuracy, maintains smooth revenue flow, and accelerates the early settlement of claims.

2. Rectify Modifier Usage

Using the right modifiers in your coding chart is crucial to getting your claims accepted by insurance companies. Coders often don’t realize the importance of using the correct modifier in their claim forms. This is when claims get rejected on the basis of wrong usage of modifiers. Incorrect usage of modifiers can also lead to significant revenue loss for medical practitioners. It will also attract compliance penalties along with claim denials.

This is where the correct usage of modifiers becomes crucial.

3. Help Increase Revenue Flow

Billing audits are a systematic method of finding the right reasons for a revenue drop in healthcare services. When your revenue flows faster, you will have enough funds to improve healthcare service operations.

Healthcare centers need to have proper supporting documents to validate the urgency for certain medical procedures and get the necessary approval. Through medical coding and billing audits, healthcare services can identify the key reasons for their revenue loss. This allows them to be more proactive and streamline documentation for faster claim approvals.

4. Help Avoid Legal Battles

Using incorrect medical codes will lead to wrong invoices being generated. When an insurance company finds out that they have disbursed a higher claim than the actual amount, they can issue a legal notice to the healthcare center to reclaim the excess amount. Such cases become more complicated if insurance carriers suspect malicious intent on the part of the healthcare service providers.

These accusations could pull healthcare centers into a lengthy legal tussle, with insurance panels (government or private) flagging them for demanding excess payment due to medical coding errors. Conducting in-house medical coding and billing service audits can save healthcare centers their reputation and revenue.

5. Useful in Evaluating Medical Coding and Billing Technology

Evaluation of medical coding and billing technology is significant for medical organizations. It highlights the efficiency and effectiveness of the existing technology. Medical claim scrubbing software can help remove rejection errors from claim submissions that can often disrupt the revenue cycle.

Medical coding and billing audits also evaluate claim scrubbing software to provide analytical insights for maintaining its efficiency in future. Regular software updates will help alleviate coding errors and further improve the quality of claims.

How to Improve Medical Coding and Billing Services

Now that the relevance of medical billing audits is well established, healthcare centers need to take the right steps to optimize their medical coding and billing systems. You can do this by:

● Getting in touch with a reliable and effective revenue cycle management software company to evaluate your healthcare service’s financial health.
● Understand the lacunae in your existing system. Be clear with your requirements concerning your organizational goals. Understand how RCM solutions can help enhance your revenue cycle.
● Use end-to-end revenue management solutions and customized plans to help your healthcare center achieve its revenue goals quickly.

Choose the Right Revenue Integrity Partner

Exdion Health offers best-in-class medical coding and billing software to enhance your revenue integrity. We offer regular coding audits for a set of claims and provide assessment reports. exdionhealth’s autonomous coding platform can provide a continuous audit of all charts or conduct a periodic assessment, based on your needs. exdionhealth conducts audits using a rule-based self-learning engine built by professional coders with years of experience in medical billing and coding. Get in touch with us to boost your revenue integrity today!

Frequently Asked Questions

Q1: What is the purpose of a billing audit?

Answer: A billing audit reviews submitted claims and billing practices to find and fix errors, prevent lost revenue, and improve compliance. It also highlights documentation gaps so clinical notes and billing better reflect the care provided — ultimately boosting accuracy and efficiency.

Q2: What is the role of coding audits?

Answer: Coding audits check that medical codes accurately reflect patient care and align with official guidelines and quality measures. They ensure coding integrity, support correct reimbursement, and help identify training or process issues that could lead to errors or compliance risks.

Q3: What are the benefits of accurate coding in healthcare?

Answer: Accurate coding ensures patient records correctly reflect care, improves communication between providers, and secures proper reimbursement. It also supports quality measurement, reduces denials, and strengthens overall clinical and financial performance.

Comments

0 Likes