Do you get paid for all your treatments? This question is asked by many. And audit is undoubtedly helpful for your practice in it. Judge for yourself, the service can identify gaps and draw attention to those areas of risk that have not been noticed. Usually, the main reasons for audit practice are a lack of charge capture of medication administration services and missed revenue opportunities. Moreover, the quality of healthcare services depends on precise and complete clinical documentation in the medical record. That is why a medical audit is a way to improve the growth level of your healthcare organization.
How medical audit will impact your practice
The primary role of medical auditors is to make an internal and external review of the precise coding and procedures of a medical provider to ensure cost-effective assistance to their patients.
Medical audits provide a mechanism to:
– Review quality of care provided to patients;
– Educate providers on documentation guidelines;
– Determine if organizational policies are current and effective;
– Optimize revenue cycle management;
– Ensure appropriate revenue is captured;
– Defend against federal and payer audits, malpractice litigation, and health plan denials.
How to find a company that will conduct the audit competently
You can come across with many professionals who only make changes to the bills by default, trying to identify problems with the drug codes presented on the claim. But it will not help you to avoid the problem. We propose to find out what ensures a healthy preventative audit process.
First of all, the company you trust must have employees who are responsible for payment entry, coding, payment reconciliation, and auditing should become familiar with and maintain a complete understanding of the following:
- drug administration coding hierarchy;
- determination of units;
- applicable dates of service;
- modifier requirements;
- NCCI edits;
- medical record documentation requirements.
However, finding a team with knowledge is only the beginning of the road. This team must be able to process the results of periodic audits, report these results, and do additional staff training when needed. The audit team or individual, depending on the size of your staff, should agree with you on the minimum requirements for the service. There are several needs for the appropriate audit sheet, such as:
– patient account;
– drug administration codes billed;
– units reported;
– date of service;
– start and stop time;
– staff responsible for the generation of charges;
– staff responsible for reconciliation of charges;
– financial impact;
– review comments.
We also advise to pay attention that the audit sheet should be created so that it can be easy to complete and read, as well as helpful in discussing issues effectively. Particular attention should be paid to the fact the audit schedule should be consistent with the frequency of billing drug administration services.
Another important fact is the outcomes and communication after the audit.