Everything About Medical Coding Audit

Physicians often get into stress with seeing an increasing number of patients, providing medical services, and following up with appropriate follow-ups that they have little time to attend to the coding and billing processes themselves.

Practices may have in-house staff who are overburdened with other responsibilities. However, documentation of medical records, timely coding and billing, and timely submission of claims to insurers are all critical in terms of revenue inflow to the practice.

Physicians must either oversee their practice's coding and billing patterns themselves or hire a medical billing company to do the same prior to claim submission. Medical bills with missing or incorrect information are usually not paid, which has a negative impact on the practice's financial situation.

Other coding errors include under coding and over coding, the former occurring when the codes assigned do not accurately reflect the complexity of the service provided, and the latter occurring when the codes report a more complex procedure than was actually provided. Both under coding and over coding can prevent proper reimbursement and even result in a payer audit.

This can be avoided if the medical practice hires a medical billing company to conduct a medical coding audit in order to identify any flaws in the in-house medical coding process.

Medical Coding Audit

An external agency, such as a medical billing company with expertise in the provider's specialty, conducts a medical coding audit on the provider. An unbiased review will provide a clear picture of the practice's coding standards, accuracy, and compliance with all applicable rules and regulations.

The audit will reveal any coding errors or misunderstandings and ensure that the physician's practice is up to date on all coding updates and rules.

The vast majority of claim denials and lower reimbursements are the result of incorrect coding and common coding misconceptions. These are easily identified during the audit. Coding audits performed by a competent medical billing and coding company can also assist in identifying errors or missing information in the medical records upon which the coding is performed.

This means that physicians will be given a signal to improve the quality of their medical records, providing clearer information to the coder and ensuring that only the appropriate codes are used. Furthermore, clarity in medical records is important for providing better quality patient care.

Be Prepared for RAC Audits

A practice that maintains a regular medical coding auditing system is well prepared for any RAC audit. RACs are recovery audit contractors hired by the CMS (Centers for Medicare and Medicaid Services) to identify and reimburse overpayments to Medicare.

They also identify any underpayments. Because RACs are paid a percentage of what they recover in overpayments, they are ruthless in their audits. RAC audits are conducted on hospitals, physicians, home health agencies, and providers of durable medical equipment.

Overpayments and underpayments are considered improper payments by the RAC. Payments for services that are not covered, such as those that are not medically necessary, services that are incorrectly coded, and duplicate services, are examples of this.

With a medical billing and coding company performing medical coding audits for you, you will be aware of any errors or inconsistencies in your practice and will be able to correct them well in advance of an impending RAC audit. You will gain in terms of time, money, and reputation.

The best part about having an audit done on a regular basis is that you can identify any underpayments and proceed to claim the appropriate reimbursement. Regular reports from your partnering medical billing company will assist you in improving the performance of your practice.

I hope this informative article will help you to make the medical coding and billing service much smoother and error-free. Do not forget to share your feedback and that will help us a lot.?