An external billing audit can help ensure appropriate payment and compliance with applicable laws. Auditing physician charges and billing practices is burdensome, but it will typically provide improved claims management processes, cash flow and compliance with applicable laws and regulations. An annual audit allows providers and practice staff to identify specific coding and other issues that may recur in similar claims submissions. Careful pre-submission monitoring and review of these similar claims may safeguard against errors that could result in claim denial.
An external audit allows the physician and practice staff to identify incorrect billing patterns before claims are denied or outside (payer) auditors access penalties.
A prospective or retrospective billing audit is commonly performed to ensure the physician is submitting appropriately coded claims as the physician is ultimately responsible for claims submission, even if a billing service or clearinghouse is used for claims submission to payers.
Physician’s offices are busy places, and it often requires everything you and your staff has just to get through the day seeing patients. Keeping track of records for errors and omissions may be a burdensome task and sometimes even impossible. While errors and omissions are not uncommon, they could be costing your office more than you realize.