Medical Coding Audits: Absolutely Essential for Every Medical Practice

The increasing demands on physicians to care for patients and provide medical services are often so overwhelming that they don’t have the time or energy to handle the coding and billing process. Many practices may have an in-house staff that is occupied with many other tasks. The revenue flow to the practice is dependent on the ability to properly document and bill the patients, as well as the accuracy of billing and coding. Either the doctors themselves must oversee the coding or billing patterns of the practice, or an outside medical billing company can do so. A practice’s financial position is affected if it doesn’t pay medical bills with incorrect or missing information. Another type of error in coding is undercoding or overcoding. These are errors where the codes assigned do NOT capture the complexity, and the latter when they report a more complex procedure that was actually performed. Both overcoding and undercoding can cause payer audits and may prevent proper reimbursement. It is possible to avoid this by having a medical billing firm conduct a medical audit to determine if there are any pitfalls in your in-house medical code. In accelerating the revenue cycle, you can use a medical coding solution from the code matrix to shorten your revenue cycle, then you need to find the best service about medical coding

The Medical Coding Audit – What Does It Entail?

Medical coding audit refers to the external review of a provider, usually by a medical billing agency that is familiar with the provider’s specialization. An impartial review of a provider will give an overview of their coding standards, accuracy, compliance and compliance with all applicable rules. The audit will reveal any coding misunderstandings or errors, and help ensure that all rules and regulations are adhered to by the physician practice.

The majority of claim denials or lower reimbursements result from incorrect coding and common misconceptions coders may have. These errors and misconceptions can easily be identified during an audit. Efficient medical billing and Coding companies can perform audits of medical records to find any missing or incorrect information. This gives physicians the opportunity to improve their medical records. The coder can then use this information to create the right codes. Clearness in medical records is essential to provide better quality patient care.

Be ready for RAC Audits

A practice that has a regularly scheduled medical coding auditing system is well-prepared for any RAC audit. The CMS uses RACs (Recovery Audit Contractors) to identify overpayments that can be repaid to Medicare. They can also detect underpayments. The RACs only receive a portion of overpayments recovered and they are extremely strict in their audits. Audits of RACs can be done on all parties, including doctors, hospitals, home health agencies and providers of durable medical equipment. The RAC defines improper payments as overpayments or underpayments. These include payments that are not covered by insurance, incorrectly coded services, or duplicate services.