The purpose of an audit is to identify and close any discrepancies in the procedural and diagnosis codes entered in the patient’s medical charts.
Accurate, detailed and complete clinical documentation is an indispensable part of quality healthcare. Medical record audits are one of the best ways to improve documentation and increase the market reputation of your healthcare organization.
Once areas of improvement are correctly identified, the findings provide an opportunity to better healthcare delivery and the financial health of the organization.
Here are the top 4 reasons internal medical audits are a necessity in the healthcare industry.
#1—Billing Mistakes Are Inevitable
This is true—however, when it happens, the healthcare provider suffers. Many might have heard of a New York-based cancer center’s narrow miss with being slammed $250,000 worth in Medicare reimbursement…all because of a typo.
It doesn’t matter who made the medical billing error. The healthcare provider is ultimately held responsible for every claim that’s billed out under their license.
A medical auditor is an important job role to ensure billers’ mistakes are corrected in a timely fashion. This is one of the reasons why consistent medical audits for all healthcare processes are necessary.
#2—Insurance Providers May Be Ignorant Of Compliance Requirements
Although every healthcare insurance provider is required to keep track of changes in their state laws and pertinent healthcare billing practices, this isn’t always the case. When this happens, providers are placed in a very tough position.
They may think that simply because they took no actions intentionally, they will not be held liable for non-compliance. However, just like in the case of any errors on the part of medical billers, the providers are ultimately held responsible for incorrect codes or discrepant medical billing charges.
A compliance audit is the only way to ensure that there is no opportunity missed to correct unintentional mistakes.
#3—Technological Advances Complicate Compliance
Despite how far modern healthcare technology has come; there is still a lot to be desired in offering patients the customized billing features they need.
For example, many physicians use the cloning feature available in most Electronic Medical Records (EMRs) that reuses the same note for multiple patients. While this may save time on similar diagnosis, it poses quite a serious compliance issue.
This is because every patient has a different medical history and a corresponding treatment plan. This means that no two patients are the same.
No matter how cumbersome, the healthcare provider needs to manually update each patient’s clinical documentation. An external medical audit ensures that this documentation process is, in fact, following all necessary guidelines.
#4—Medical Investigations Are Costly Affairs
It’s crucial to keep medical billers and coders updated on all the pertinent regulations. In case there are any unintentional errors, providers might face a huge challenge.
The biggest one is an external investigation in to the minute workings of the medical facilities and its practices.
It’s best to find time to train professionals on your own terms rather than have it inflicted upon you as a legal requirement.
When in doubt ask yourself this, is an external investigation worth it?
Bottom Line
There is no doubt that internal medical audits for regulatory compliance and billing processes are a necessity for any healthcare facility.
It’s possible that the medical billers and coders on your team may be making innocent mistakes, but these mishaps could potentially turn into a serious expense for your business.
Allied Prep Technical Institute is a leading medical technical institute that offers comprehensive professional medical auditor training courses both online and on-campus. We also provide rigorous certification courses for aspiring medical billers and medical coders.
To find out more about our services, email us at alliedpreptech.com.