Medical billing is a complex task where many things can go wrong. It takes a seamless, highly efficient system to conduct medical claims processing without critical errors. Even minor mistakes can spell trouble for healthcare providers, insurance companies, and patients. One of the best ways to prevent billing mistakes and payer audits is with regular self-audits. Self- auditing the right way could save your office.
Common Billing Errors in Medical Claims Processing
To understand the value of self-auditing, first explore the many errors that could harm a physician’s office. Billing in the medical field requires innumerable charts, codes, and communications between parties. It’s easy to make an error that snowballs into a massive problem. Before a billing error gets out of hand, there are steps you can take to prevent it from ever happening in the first plane. You may already have examples of errors from real life, which is why you’re reading about self-auditing. If not, here are three of the most common medical claims mistakes:
1. Coding problems. Every medical biller knows the job depends on codes. CPT codes, point of service codes, and ICD-9- CM codes may all come into play during claims processing. Entering the wrong code, getting codes confused, or entering too few or too many digits can be disastrous. Coding problems can lead to major issues down the road. Organizations update the three principal medical coding sets annually. It’s important to update manuals every year.
2. Processing errors. Medical billing specialists may overlook parts of a claim or enter them incorrectly when processing many claims in the same day. Common mistakes include entering incorrect patient and/or provider information, failing to verify the patient’s insurance coverage, or confusing two different claims. It is imperative for billing specialists to enter every piece of information correctly on a claim for it to process correctly.
3. Security breaches. One of the scariest things that can go wrong in medical billing is a security breach. Sensitive patient information can become vulnerable if there are holes in your electronic security, opening the company to disaster and possible lawsuits. A major security breach can make a physician’s office close its doors forever. Regular self-audits can ensure the security of the office’s electronic systems, helping to keep bugs and hackers away.
These are just three of the many things that can go wrong during medical bill processing. Despite years of training and education, even the most prudent specialist can make a mistake that leads to issues with the bill down the road. It’s always better to prevent billing issues before they occur rather than to try to repair damage an error already made. Self-audits are the ultimate way to safeguard an office from billing, claims, and processing errors.
What Is a Self-Audit?
If you’ve been in the billing industry for any amount of time, the word “audit” may strike fear into your heart. You may associate it with payer audits, and in-depth examinations of how your office and specialists perform their jobs. Audits may occur at random, or they may happen after a significant error. Either way, they are something that every physician’s office wants to avoid. Self-audits can provide a means of preventing payer or federal audits, by keeping the system performing according to accepted standards year round.
During a self-audit, everyone involved in coding, billing, and processing will scan the system for issues, red flags, and potential patterns that could develop into errors in the future. The entire team will work together to assess current processes, check for problems, and discover if there is room for improvement. Self-audits are opportunities to find bugs, fix them, and minimize errors in the future. Experts recommend performing self-audits at least once per year, or more frequently depending on resources and the individual situation.
The size of the practice and the adoption of new systems may require more frequent auditing. New systems may have transition periods where the rate of error is higher as coders get familiar with new software. Increasing the rate of self-audits during this time can help prevent small and large issues with new programs. The same is true if an office hires a new staff member. Auditing the new addition within 30 days or so can assess his or her performance and optimize training.
Benefits of Self-Auditing
Conducting annual or bi-annual self-audits may feel like a burden on your team. However, the time and effort it takes to audit yourself once per year is minor compared to the hassle of a major payer audit or serious mistake on your end. Major billing errors can disrupt the system, look bad for your office, and potentially cause problems for the patient. Instead of waiting for an accident
to occur and then scrambling to fix it, conduct regular self-audits to catch potential problems before they ensnare you.
The main benefit of self-auditing is to find and fix information gaps, poor documentation, incorrect coding, and other mistakes. Yet the practice is also good for more than just problem solving. An office that performs annual self-audits on medical claims processing can enjoy fully optimized operations, with no subpar processes that cost the company money. It can also help your team prepare for external audits in the future.
An audit can revise and improve procedures until they are the best they can possibly be, leaving no room for costly errors or losses in productivity. An audited workforce is one with the tools and knowledge to move forward using tried and true processes, with no time wasted. Audits can turn any office into a well-oiled machine – saving the company money and headaches. Improved claims acceptance translates into more cash flow for the physician’s office.
How to Complete a Self-Audit
The ability to prevent medical billing issues comes down largely to the efficiency of the self- auditing process. Learning best practices for billing self-audits such as what to look for and how to revise issues can keep this task as fast and simple as possible. The point of a self-audit is to benefit your company. Use an audit to its fullest potential by following this general three-step outline:
1. System inspection. Select a group of charts for your team to examine within the last six months. Examine the records for missing information, lack of documentation, and incorrect coding. Make sure everyone performing the audit uses the same techniques. Provide a checklist of what to search for with each chart check.
2. Problem detection. If coders have the time, use them to conduct your self-audits. Otherwise, you may want to hire an external auditor. Put coders on alert for potential problems. Coders will report to a designated manager if they see anything suspicious, for immediate appraisal and appropriate action. Appoint a compliance manager who will be in charge of investigating potential problems.
3. Issue revision. If the auditors find anything wrong or suspect within the billing system, take time to investigate the issue and to come up with an appropriate response. This is your chance to fix holes before they turn into major leaks for your company. Think about whether a system upgrade would solve or prevent the problem in the future. Self-audits are great for performance reviews, assessments, and new technology integration.
Every office’s self-audit will look different. The most important thing as that the process works for you and your team of specialists. Tailor a self-auditing plan and timeline for your specific office’s needs and goals. Train those involved on how to perform the audit, and make sure a manager oversees the process. Don’t let coders audit their own work. If your self-audit shows signs of outdated equipment and inefficient processes, consider upgrading your medical billing software.
Optimize Billing with the Right Software
The goal of a self-review is to revise and optimize your procedures. Stay vigilant about even the simplest of mistakes. You’ll find that your team can avoid most medical billing mistakes well before sending claims for processing with the payer, all by keeping an eye out for common errors. It’s up to your office to move the claims through the system as quickly and accurately as possible. To stay on track, look at whether you need to enhance key elements such as communication, coordination, or billing and coding technology trends.
As you uncover issues, you may find that it would be in your office’s best interest to invest in new claims processing software. Medical billing software from a trusted medical billing clearinghouse can help streamline processes to avoid future billing errors and “real” audits. Upgrading your system to implement a new billing management program can be exactly what your office needs to operate smoothly and effectually in the future. Billing and coding in the medical industry are important jobs. The right software can minimize costly mistakes.
Apex EDI provides simplified medical claims processing, with much less room for human error. You can instantly eliminate many common mistakes in coding and processing when you use Apex EDI to process your insurance claims. The system works perfectly with any practice management software, allowing effortless communications between health providers and insurance companies. It has a simple user interface for smooth adoption and no-hassle employee training. Apex EDI is a cutting-edge software that can bring medical billers into the 21 st century. With the right program, you won’t have to dread audits.
www.practicesuite.com/practicemanagement/avoid-medical- billing-issues- with-a- self-audit/
www.m-scribe.com/blog/bid/344908/8- Easy-Steps- to-a- Great-Chart- Audit-to- improve-medical-billing
www.cms.gov/Medicare-Medicaid- Coordination/Fraud-Prevention/Medicaid- Integrity-Education/Downloads/ebulletins-self- audit.pdf