So, what exactly is a billing and receivables audit? It’s an assessment, typically conducted by a third party, that examines the effectiveness and reliability of procedures used by a medical practice surrounding its billing and accounts receivables (money due the business).
The audit is used to ensure the patient bills are submitted correctly, with the proper codes for insurance reimbursement, and that best practice processes are followed when it comes to payment posting, collection, and reporting. It may also look at how insurance denials are managed and if/when/how they are appealed.
A billing and receivables audit can identify, monitor, and help rectify inappropriate billing or collection practices. By spotlighting potential problem areas that a medical practice can rectify, there is an opportunity to improve a practice’s bottom line.
Billing and receivables audits may seem like a luxury, but these audits are actually the opposite. An audit is critical to ensuring a medical practice is properly and efficiently conducting its business so that it can continue to do what it does best: deliver medical care and services to those who need it.
The audit can find and focus on problematic trends or areas of increased risk to the practice. It can address the frequency of provider services, payer mix, as well as clinical staff needs and training, especially billing and coding staff. Making sure your coding staff is up-to-speed and using correct codes for services can help prevent claim denials and delays in collecting receivables.
Depending on the findings of the audit, corrective actions may be recommended to improve a medical practice’s operational success. This can optimize the business’ revenue cycles as well as management and care outcomes.
Internal audits are those performed by a team of in-house specialists. This is typically done by larger-sized organizations with qualified employees to field an audit team.
An external audit is performed by an external team or nonemployee pool. They have zero vested interest in having the findings come out one way or another, as they are not colleagues or employees. Likewise, this lack of bias can ensure their recommendations carry more weight with management. Small practices benefit greatly from this type of audit.
If you’re interested in an assessment of your billing and receivables process, contact ProMD Practice Management and ask their medical business experts to conduct an in-depth audit. You can call them at 888-622-7498 or request a consultation now to improve your practice’s bottom line.