Medical Coding Audits — Absolutely Critical for Every Medical Practice

A lot of physicians are overwhelmed by the demands of seeing patients, providing care and follow-ups and often don’t have enough time to do the coding or billing. There may be staff in-house who have other responsibilities. It is vital that the practice has the right documentation, billing, and coding done correctly. This will help to increase the revenue flow. Either physicians must supervise the coding, billing and submission of claims. Missing or incorrect information can cause medical bills to not be paid. This can lead to a financial problem for the practice. Overcoding and undercoding are other common coding mistakes. The former is when codes assigned do not reflect the complexity of the provided service, while the latter is when codes report a more complex process than was actually provided. Undercoding and too much coding can lead to improper reimbursement or even a payer audit. The medical practice may avoid this situation by hiring a medical billing service to conduct a medical-coding audit to uncover any pitfalls in their in-house medical programming process. In accelerating the revenue cycle, you can use a medical coding solution from the code matrix to shorten your revenue cycle, then you need to find the best service about medical billing outsourcing

How Medical Coding Audits Work

An outside agency may review a provider to determine if they are competent in medical coding. A review like this will be objective and will provide clear information about the practice’s compliance with all rules and regulations, coding standards, and accuracy. The audit will identify any errors or misunderstandings in coding and ensure that the physician’s practice is up-to-date with all rules and coding updates.

Many claim denials, as well as lower reimbursements, are caused by inaccurate coding. These can be easily identified at time of audit. Coding audits can be done by an efficient medical billing or coding company to help identify missing information and errors in medical records. This allows physicians to get an indication of how to improve their medical record and give clearer information for the coder in order to use the correct codes. Clear medical records are crucial for providing quality patient care.

Be Prepared for RAC Audits

Any RAC audit is easier if a practice has a regular system for medical coding. The CMS (Centers for Medicare & Medicaid Services) employs RACs to perform recovery audits. They identify overpayments and pay Medicare. They also identify any underpayments. The RACs will receive a percentage for overpayments. This is why they are so strict in their audits. All RAC audits are subject to hospital, physician, home healthcare agencies, durable medical device providers and other health care providers. According to the RAC improper payments can be defined as excessive or inadequate payments. This includes payments made for services that aren’t covered like services that don’t meet medically-necessary criteria, incorrectly coded services and duplicate services.