Medical Coding Audits – Essential for Every Medical Practice

Doctors often feel so overwhelmed with the increasing number of patients they see, providing appropriate medical services, and following-ups that it is difficult for them to take time to code and bill. In-house staff may also be employed by practices, but they may be occupied with other tasks. From the perspective of revenue flow, the importance of documenting the medical records, coding and billing correctly, and submitting claims to insurers is all important. Either doctors have to monitor the coding patterns and billing practices of their practice or a medical billing firm must do so before the actual claim submission. The practice’s financial health is often affected by medical bills that contain missing or incorrect information. There are two types of coding errors: overcoding or undercoding. This happens when the codes assigned fail to capture the complexity and/or extent of the service. The latter is when the codes report a more difficult procedure than the actual one. Undercoding and overcoding could prevent payment and trigger audits from the payer. A medical billing company can help avoid these problems by conducting a medical coding audit of the medical practice to find any issues in the in-house medical codes. 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

Medical Coding Audit – What It Is

A medical coding audit is the process of reviewing a provider by an outside agency. This could be a billing company or medical billing company with experience in that provider’s area. The review will be impartial and give a clear picture of the practice’s coding standards and accuracy as well as compliance with all applicable laws and regulations. The audit will uncover any errors and misunderstandings regarding coding, and ensure that the physician practice follows all the most recent coding rules and updates.

Incorrect coding and common misconceptions among coders is the main reason for most claim denials. These issues can be easily identified during an audit. An efficient medical billing company and coding company can perform coding audits to help find errors or missing data in medical records. This will give physicians a chance to improve the quality and communicate with the coders so that they can use the correct codes. Clarity in medical records is important for better patient care.

Be prepared for RAC Audits

A practice with a regular medical coding system is prepared for an RAC audit. The CMS employs recovery auditor contractors called RACs to help identify overpayments, and then reimburse Medicare. If there are underpayments, they also identify them. The RACs get a percentage from overpayments. They are therefore very thorough in their audits. All RAC audits can be conducted on hospital, physician, home-health agencies, durable medical equipment providers, and hospitals. The RAC considers improper payments overpayments and underpayments. These are payments for services that do not fall under the RAC’s coverage, such as services that cannot be coded correctly or those that are not medically required.

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