medical necessity.
This last point is especially important, since various payers may dif-
fer in their understanding of the necessity of the service. Every claim
should have information in it that appropriately states the medical
necessity of the service. This is one area where a lot of providers
make mistakes, so make sure your auditor is looking at this closely.
Record and understand your audit's results
If your auditor finds errors on your end, make sure she records
the problems so you can implement solutions to prevent similar issues
in the future. If the payer inaccurately processed claims, for example,
the auditor should set those aside and contact the payer to discuss the
issue. Your auditor should document the audit's results via reports,
graphs, spreadsheets and charts, which will better help you identify any
recurring problems or trends. These reports should include the date
when the auditor spotted any discrepancies in claims, and whether
these were rebilled or refunded, if appropriate.
Refining your revenue cycle
Although the process can be taxing, regular audits improve cash flow.
They show you where there is leakage in revenue and help identify
ways to curb it, whether the issue is a lack of efficient documentation,
coding errors, problems in your billing department or issues with a
payer's reimbursements. Once you finish the audit and identify the
errors, make sure that you implement solutions and regularly check
up on these coding or billing trends to continue to improve your rev-
enue cycle.
OSM
Ms. Gupta (prerna@meddatacarepro.com) is the director of strategies for
medicalbillersandcoders.com and of Med Datacare Pro, a revenue cycle man-
agement company.
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