Auditing for Compliance

Medical Billing

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An audit is a process of review for accuracy and efficiency based on regulations and procedures. Audits help identify billing and coding issues before they escalate, which allows medical practices to rectify errors before they are subject to government repercussions and fees. An audit can be conducted internally or externally and may be done pre-bill or post-bill.

Why are Audits Important?

Audits are conducted to ensure that coding is done according to regulations, claims are billed accurately and documentation supports the coding. They are also helpful tools to show areas where further training and improvement are necessary.

What is Typically Audited?

Certified Professional Coders (CPCs) can help your practice identify risk areas and make those the focus. They will consider past audits, weak areas, new procedures, new employees, etc. A narrow scope for the audit, which targets specific areas and periods, can help your practice find deficiencies and make plans for improvement.

How are Audits Conducted?

Once the auditors have identified what is to be reviewed, they will define the objectives of the audit and run a report under that scope. Typically, the process involves:

  1. Deciding how many accounts will be reviewed based on the whole population. The auditors will ensure that the sample size is an accurate representation of the whole and that the sample is randomly selected.
  2. Examining the documentation in the medical records for the samples. The auditors will compare the documentation to the codes billed to make sure they are accurate and record the results for each of the samples.
  3. Summarizing and presenting the audit findings. Based on their results, the auditors will create a plan of action for correction and improvement moving forward.

Yeo & Yeo Medical Billing & Consulting offers both on-site and remote auditing services. We have Certified Professional Coders on-site that are experienced in performing audits for a variety of practice sizes and specialties. If you have questions regarding our audit services or would like to schedule an audit, please contact us.

Refrence: Smith, Amy Lee. “Audit to Promote Revenue Integrity.” Healthcare Business Monthly, 1 Mar. 2019, pp. 44–47.


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