Conducting an Audit
Quality health care is based on accurate and complete clinical documentation in the medical record. And the best way to improve your clinical documentation and financial health of organization is through medical record audits.
The perfect scenario there is a constant communication between coders and clinical staff to ensure that correct and appropriate codes been assigned in order to avoid denials.
Medical coding and billing involve complex processes that can differ depending on the patient, insurer, and procedure. Even the most diligent financial services departments experience claims denials but knowing the most common mistakes can help you take steps to avoid them.
Some of the issues that can be identified with a chart audit are:
Are bills accurately coded?
Does the documentation support the service coded and billed?
Is the documentation complete? (Signatures, patient name, date of birth)
Are services or items reasonable and necessary?
There are many reasons to perform medical audits:
Protect against fraudulent claims and billing activity
Help identify and correct problem areas before insurance or government payers challenge inappropriate coding
Identify reimbursement deficiencies and opportunities for appropriate reimbursement.
Stop the use of outdated or incorrect codes for procedures.