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A small OR Mid Size practice can be a busy place, and often there just aren’t enough hours in the day to attend to the task of a medical billing audit. It’s no surprise that there are companies that specialize in this area, providing education, consultation, and recommendations for improvement.
External auditors are immune to conflicts of interest that may otherwise compromise an internal audit staff. An up coded bill is often providing increased revenue, which, for most, is a huge problem. Experienced external auditors know where to look for issues such as this that may be missed by less objective eyes.
In a medical billing audit, billing document’s and coding are two of the most important areas tested. If a bill is not coded properly, than the revenue is Gone. If this happens on a consistent basis, even a small mistake can become quite substantial to the practice financially. Over coded bills generate more revenue than they should, and if discovered, that money must be returned to the payer. If over coding is discovered by the OIG, the money will be demanded by Medicare, the practice may be fined and it may even be put on OIG pre-payment review. Transposed CPT numbers or even inaccurate patient data can also result in denied claims. The audit process can identify all of these errors.