How medical billing and accounts receivable audits increase productivity?

Sep 4,2020

Audit in the simplest of terms means inspection for quality. Why do audits play such a predominant role in Medical Billing? Answer is very simple, to primarily increase profitability. Profitability does not just mean revenues; it also means getting good reviews from both patients and the governing bodies for the providers. Insights provided because of audits enhance the FPR (First Pass Ratio). Each provider setting will have varied audit requirements and comprehension of the same will enable providers to identify the best methods that fit their individual needs. Let us dive a little deeper to understand the importance of audits in Medical Billing.

Importance of Auditing:

  • Helps identify errors and their frequencies

  • Paves way for SWOT analysis

  • Disputes can be anticipated

  • Efficiency can be improved.

  • Training needs and Operational gaps can be detected.

Purpose of performing the Billing Audit:

 Audits be it internal or external have a common objective of improving accuracies and eliminating fraudulent activities.  They provide an understanding on the approach, techniques used and outcomes. While Medical audits assure you proficient and tidy operations, they also motivate the providers to evaluate the billing processes, secure against fraudulent claims, challenge incorrect coding, realize the missed opportunities on reimbursements, and pave way for operational excellence in performing various functions associated with billing such as patient scheduling and eligibility verification processes.

While billing audits help in combatting the rejections and denials, Accounts receivable audits help the providers know the roadblocks in cash flows such as:

  • Proper receipt of claims by payers

  • Payment discrepancies with reference to contracts and fee schedules.

  • Ratios of Contractual Adjustments and Non-Collectible Write offs.

  • Identification of pseudo and incorrect denials

  • Appeals efficiency and turn around.

  • Reasons for Aging AR and the responsible parties for reimbursements.

Emphasis must be given for Audits due to the enormous benefits associated with them. Some of them are listed below: 

  • Adherence to Compliance Standards

  • Reduction in Fraud, Waste and Abuse

  • Efficiency improvement both qualitatively and qualitatively.

  • Identification of deficiencies both in processes and resources.

  • Increased accuracy and reduction in backlogs.

  • Improved patient satisfaction reviews for providers

  • Optimizing time and resources.

  • Improved revenues with consistent cash flow.

Phani Ram