At PrecisionMed Works we provide comprehensive medical auditing and reporting services for your healthcare facility to eliminate errors and mitigate risks by facilitating regulatory compliance. .
Medical auditing entails conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and hopefully liability-free operation. Sometimes all your practice needs is an outside perspective and expertise to enhance your practice’s efficiency and revenue. Policies and regulations in medical coding and billing are constantly changing which increases the complexity of this field. As, operations of a healthcare practice are based on significant amount of clinical documentations and medical claims, for which proper knowledge of medical coding policies is important to ensure accuracy. In this regard regular audits also significantly helps a practice to evaluate its processes, documentations and transactions to eliminate error, ensure accuracy and improve revenue cycle management.
Auditing Goals
The basic goal of performing medical audit is compliance, as OIG (Officer of Inspector General) recommends annual review of healthcare practice’s coding and documentation audit. As, it helps to ensure accuracy and efficiency of each and every step of revenue cycle management. Our team of certified auditors CPMA (Certified Procedural and Medical Auditors) from AAPC, focus on every aspect and utilize standard benchmarks to evaluate your practice against different key performance indicators. The auditing process can be focused to
- ZIdentify and eliminate errors in clinical documentation to ensure compliance.
- ZEvaluation of charts/ encounters to ensure physician is properly reimbursed for the services provided.
- ZIdentify inefficiencies in payer reimbursement.
- ZAssuring proper application of CMS and CPT guidelines and principles in medical Coding to avoid under and overcoding.
- ZDetermine usage of incorrect medical codes, such as use of deleted or modified codes, further evaluating use of modifier.
- ZUncover areas of payer rules if medical practice billed inappropriately.
- ZIdentify fraudulent billing practices, to mitigate risk.
- ZIdentify errors in claim scrubbers or claims software deficiencies utilized by the medical practice.
- ZDetect payment variances, flag underpaid and incorrectly closed claims and identify inappropriate denials and rejections.
- ZAddress areas of risk to avoid legal action.
- ZHelps to improve overall billing integrity by training staff on best practice front- and back-end billing processes.
We also highlight root cause issues and make recommendations to improve the process, streamline it and educate their staff to ensure the efficiency and accuracy of medical practice. It not only assures that practice is in compliance but also improve the quality of patient care and overall improves the revenue cycle management and financial health of the organization.