Did you know that more than 40% of Medicare E/M services lacked correct coding, according to study conducted by the Office of the Inspector General? Medical billing and coding mistakes could cost your business more than just revenue declines. Medicare paid out roughly USD 7 billion for claims that were incorrectly coded. When CMS discovers organizations for making misleading billing claims, these instances may come back to haunt them. By conducting routine medical billing audit at your company, you may prevent these incorrect circumstances.

Audits are quite advantageous for the medical organization because they can identify the problems that are financially draining the healthcare system. Additionally, they assist you in making the proper decisions at the appropriate times to prevent coding and billing-related legal issues. The vast number of patient accounts and the sizeable number of claims submitted each day, however, means that very few businesses concentrate on audits. Here are some of the main justifications for why you should examine your company’s medical coding and billing operations.

1. Audits assist in locating recurring coding errors:

• To accurately capture the services code and preserve the revenue flow, all medical organizations must have competent coders working under their direction.
• Administrative overhead, however, might occasionally degrade the caliber of in-house coding services and result in repeated coding errors that are not always recognized.
• Audits obtain a thorough study of the problematic coding patterns. They can differentiate between one-time mistakes and persistent ones.
• Medical audits have found that outdated codes are the most frequent sort of repeated errors.
• Coders frequently utilize redundant codes in their claims because they are not aware of the most recent changes to the coding standards.
• You’re medical coding and medical billing services could greatly benefit from replacing these areas of improvement, which would increase the organization’s cash flow.

2. Clarify the use of modifiers

• For claims to be approved by the insurance company, the proper modifier must be used in the claim’s coding chart.
• But regrettably, many code teams prefer to misuse modifiers because they are unaware of their significance.
• For instance, if the patient’s complexity has changed the mentioned operation, a modifier must be used to support the parent process.
• However, the intricacy that prompted you to utilize the modifier must be amply demonstrated by the thorough medical records.
• In other instances, the organization’s revenue is below expectations since the coding team didn’t fully utilize the modifier in the coding file.

3. Increase your revenue flow:

• An audit may enable you to approach the issues more methodically if your firm is suffering a drop in revenue flow but you are unable to identify the cause.
• Inadequate coding, unbundling practices, and a lack of documentation have all been shown to cause firms to lose out on revenue, according to audits of several medical coding departments.
• To prove that the surgery was actually conducted, medical claims must have the appropriate supporting documentation. It also emphasizes how critical the services provided are for medical reasons.
• You won’t be able to collect the entire amount you are owed, however, without the relevant codes and all necessary proof.
• In some other situations, the payments may become excessively late, resulting in an aged A/R, and the insurance company may request specific documents to prove your services.

4. Prevent legal disputes over medical billing and coding services:

• If the insurance provider discovers an account where they have overpaid the provider because of coding problems, they will send you a legal notice to recover the overpayment.
• If they suspect any hostile action on your behalf and accuse the company of upcoding operations, the situation could become more complex.
• Insurance panels, whether public or private, will flag your company for overpayment owing to inaccurate coding, which you will be required to recoup.

Health institutions are being warned by HHS this year for billing errors. The tale can be read here.

• The zone programme integrity contractors, recovery audit contractors, or any other governmental investigational auditors may also pay you a visit to look into the situation.

• Regularly auditing your medical coding on your own will prevent you from suffering financial and reputational loss as a result of legal disputes.

5. Assess the assistive technologies you use for medical billing and coding services:

• The software for medical claim scrubbing is used by many healthcare organizations to eliminate any mistakes that can affect their income flow.
• However, it is advisable to regularly assess the technology employed in your business to see whether it is actually performing as intended.
• Technology that automates processes greatly reduces manual errors. But you should also consider whether the software has been appropriately updated.
• A thorough analysis of what you can do more to uphold a better level will be given to you following an audit that also evaluates your claim-scrubbing software.
• Updating your programme will reduce your coding errors even more, enhance the validity of your claims, and boost your rcm.

What can you do to make your medical billing and coding services better?

• The details of your company’s revenue management deficiencies will be captured by audits. But in order to fully correct problems, you must take the appropriate action.
• Contact a reputable revenue cycle management business to have your financial situation assessed.
• Talk to the professionals about your particular organizational goals and find out what they can do to support you in achieving them.
• RCM firms can support you in reaching your objectives and can offer you specialized coding teams to manage your claims.
• They offer complete revenue management services as well as specially designed plans to help you reach your objectives quickly.