Are you tired of dealing with denied claims and lost revenue?
Medical billing can be tricky. Even small errors can lead to major financial losses.
But did you know—these errors can be found and fixed?
A medical billing audit is the solution you’ve been looking for.
This detailed checklist will make the audit process easier for you.
Ready to get started?
Let’s first discuss what a medical billing audit is before exploring its checklist.
What Is A Medical Billing Audit?
Medical bill auditing is the process of reviewing billing and clinical records. It checks if the information is accurate, reliable, and follows the right guidelines. The audit also examines the billing documents sent to payers to find errors.
An audit involves handling various documents, like clinical and financial records. It's important to gather all relevant data in one system and keep it well-organized.
By conducting a thorough audit, you can avoid billing issues and ensure you're getting paid correctly.
Key Components of a Checklist
It is a valuable tool to help you navigate your process and make sure nothing is missed. Here are the essential parts to include:
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Patient Information
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Charges and Coding
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Claims Submission
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Payer Policy Compliance
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Documentation Accuracy
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Payment Posting
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Denial Management
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Revenue Cycle Review
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Staff Training
How to Audit Medical Billing: A Complete Checklist
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Verify Patient Information
Make sure the details of the patient, like name, birth date, and service dates, are accurate. Cross-check this information with the billing documents.
It is also important to confirm that the patient's insurance was valid on the service date.
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Check Provider Information
Ensure that the healthcare provider listed is licensed and authorized to offer services. Review the billing documents to verify the correct provider is listed for each service.
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Look for Duplicate Records
Check for any duplicate claims or records for the same service date. Review the previous claims to see which codes were paid or denied.
Ensure no bills were split into multiple claims unnecessarily.
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Verify Electronic Health Records (EHR)
Make sure patient IDs match across all records. Double-check that the information is complete and accurate.
Verify that medical history, allergies, and other essential details are accurately recorded.
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Review Medical History and Visits
Check that all patient visits, exams, and follow-up appointments are listed in order. Ensure each visit includes details from both the primary physician and specialists, as well as the dates and provider information.
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Verify Diagnostic Reports
Make sure lab tests and imaging results are linked to the correct diagnosis. Ensure reports are complete, signed by the appropriate provider, and contain necessary interpretation details.
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Check Diagnosis and Treatment Plans
Make sure the final diagnosis matches the treatment plan. Make sure that all lab results and consultant reports support the primary care physician’s findings.
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Review Procedure Details
Check the records for details about each procedure, like the date and materials used. Confirm that consent forms are signed and that any missed appointments are listed.
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Verify Medication Records
Check that all prescriptions, including refills, are documented. If a medical device was prescribed, ensure there is a valid prescription.
Confirm that post-treatment instructions and follow-up details are included.
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Verify Codes and Billing Formats
Check that the correct CPT and ICD codes are used. Verify that the assigned codes align with medical records. Look for proper modifiers, correct unit billing, and avoid issues like miscoding or upcoding.
Make sure the billing always complies with payer regulations.
How to Implement an Audit Checklist
To implement an effective checklist, you need a strong team and clear processes.
To begin, follow these steps:
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Define the Purpose of Audit
Set clear objectives and decide what needs to be checked.
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Build a Skilled Team
Gather a team with knowledge in coding, billing, compliance, and audits.
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Create Clear Procedures and Checklists
Develop detailed steps for the audit process, so nothing is missed.
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Train the Team Effectively
Make sure the team understands billing rules, coding, and audit methods.
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Use Technology
Use billing software, analytics tools, and automation to improve efficiency.
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Set Up Quality Control
Have measures in place to ensure accuracy and consistency throughout the audit.
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Encourage Open Communication
Encourage collaboration among team members and other stakeholders.
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Review the Process Regularly
Monitor the audit’s performance and make adjustments as needed to improve results.
Why Outsource Your Medical Billing Audit?
Conducting an audit in-house can be challenging. Billing rules are complex and change often, which makes it difficult to stay updated. Training staff takes time, and using the right tools needs expertise. There’s also a chance of missing important details or being biased.
At Dilijent Systems, we simplify this process for you. With years of experience, our experts make sure your claims are accurate, compliant, and processed quickly. We have years of experience, advanced tools, and a proven track record of improving reimbursement. Contact us today to schedule your free consultation.
Conclusion
Regular medical billing audits aren’t just about compliance; they are essential for healthcare success.
A checklist is a guide to meet your audit needs. Creating a checklist and clear process reduces confusion, improves accuracy, and helps you get paid on time.
FAQs
How Often Should A Medical Billing Audit Be Done?
Healthcare organizations should perform audits at least once a year. Larger practices may audit every few months.
Why Is Medical Billing And Coding Auditing Important?
Auditing helps to ensure compliance, improve profitability, maintain data quality, and improve services.
What Does An Audit Review?
It checks patient data, billing codes, claims, payments, and insurance details.
Can Audits Reduce Denied Claims?
Yes, audits find errors early, which can help reduce the number of denied claims.
How Long Does A Healthcare Audit Take?
It depends on the size. It can take a few days to several weeks.
