Medical Billing and Coding Audits
Medical billing and coding errors can result in significant financial losses, legal liabilities, and reputational damage for healthcare providers.
RPM Medical Billing offers professional audits to ensure your practice’s operations are accurate, compliant, and efficient.
What are Medical Billing Audits?
A medical billing audit systematically reviews a healthcare provider’s billing processes, coding accuracy, and patient documentation to ensure compliance with industry standards and payer regulations. These audits help identify discrepancies such as incorrect coding, incomplete records, or missed charges that can lead to claim denials or financial penalties.
By proactively addressing errors, medical billing audits enhance the accuracy of claims, maximize reimbursements, and maintain compliance with Medicare, Medicaid, and private insurance guidelines. Regular audits improve a provider’s revenue cycle, ensuring proper documentation and safeguarding the financial health and integrity of the practice.
Why Choose RPM Medical Billing for Audits?
- Comprehensive Expertise: Experienced professionals specializing in identifying and resolving complex coding errors.
- Proven Track Record: Trusted by healthcare providers for achieving accuracy and compliance.
- Regulatory Knowledge: Expertise in CPT, HCPCS, ICD-10 standards, and payer-specific requirements.
- Independent External Audits: Objective reviews uncover errors that internal teams might miss.
- Industry-Leading Systems Knowledge: Familiarity with EHR and practice management systems, including:
- eClinicalWorks
- Greenway Primesuite
- Allscripts Pro
- GE Centricity
- Epic
Why Choose RPM Medical Billing for Audits?
Risks of Inaccurate Medical Billing and Coding and Our Solution
Medical billing is a complex process. Even minor errors can lead to significant financial and operational challenges for healthcare providers. Here are some common billing issues and how RPM Medical Billing provides effective solutions:
1. Billing Errors
- The Problem: Mistakes in data entry, duplicate billing, or inaccurate patient information can result in claim rejections or delayed payments.
- Our Solution: Our team reviews all claims for accuracy and completeness before submission, reducing errors and ensuring faster reimbursements.
2. Coding Errors
- The Problem: Incorrect or outdated coding, such as using the wrong CPT or ICD-10 codes, can lead to claim denials or compliance violations.
- Our Solution: Our certified coders stay up-to-date with the latest coding standards and regulations, ensuring that every claim reflects the proper codes for the services provided.
3. Compliance Issues
- The Problem: Noncompliance with federal regulations, such as HIPAA or payer-specific guidelines, can result in hefty fines and legal risks.
- Our Solution: RPM Medical Billing ensures compliance with all state, federal, and payer regulations through regular audits and ongoing staff training.
4. Reimbursement Cuts
- The Problem: Insurers often reduce reimbursement rates, impacting a provider’s revenue. Additionally, properly coded claims can lead to higher payouts.
- Our Solution: RPM Medical Billing negotiates favorable payer contracts and ensures accurate coding to capture maximum reimbursements. Our revenue cycle experts analyze payer trends to mitigate the impact of reimbursement cuts.
What to Expect During a Medical Billing or Coding Audit
- Define Scope: Tailor the audit to your needs for specific payers or a full operational review.
- Gather Documentation: Collect all relevant records, including bills, patient charts, and internal policies.
- Analyze Data: Cross-check codes with documentation to uncover discrepancies.
- Detailed Reporting: Provide actionable insights with recommendations for improvement.
Why Choose External Audits?
External medical coding audits provide unbiased reviews, eliminating internal conflicts of interest and ensuring objective results. With extensive experience working with various healthcare providers, external auditors bring valuable insights to improve processes and optimize operations. This expertise, combined with a fresh perspective, helps identify errors and implement effective solutions that need to be noticed.
Additionally, outsourcing audits is cost-effective, saving healthcare organizations from the expense and logistical challenges of building and maintaining an in-house audit team. Providers can enhance compliance, accuracy, and efficiency by choosing external auditors while focusing their internal resources on delivering exceptional patient care.
Key Features of RPM Medical Billing Audits
At RPM Medical Billing, we offer a full range of audit services tailored to enhance your revenue cycle, improve compliance, and ensure operational efficiency. Our audit solutions are designed to identify and resolve issues at every stage of the billing process.
Internal Audits
We thoroughly review your internal processes and documentation to ensure they align with industry standards and best practices. Our team provides actionable recommendations to improve performance, enhance accuracy, and boost efficiency.
External Audits
Our independent audits focus on claims and payments from third-party payers, including Medicare and Medicaid. We resolve billing disputes, recover underpayments, and address aged receivables to improve cash flow.
Prospective Audits
We proactively evaluate claims before submission to payers to ensure they are accurate, complete, and compliant. We help you secure faster reimbursements and maintain a healthy revenue cycle by preventing denials, rejections, and delays.
Retrospective Audits
Our team analyzes claims after processing to identify errors, appeal denied claims, and recover lost revenue. This post-payment review ensures your operations remain compliant and optimized for maximum profitability.
Comprehensive Practice Audits
We take a holistic approach to auditing your medical practice’s billing, examining everything from coding and billing accuracy to documentation and compliance. This in-depth evaluation identifies systemic issues and provides a roadmap for long-term improvement.
Protect Your Practice with RPM Medical Billing
Don’t let medical coding errors put your healthcare practice at risk. With professional coding audits, RPM Medical Billing ensures accuracy, compliance, and peace of mind.
