Audits are important tools that ensure the proper management of finances with a strict adherence to established rules and regulations why exploring areas where internal process improvements can be implemented.
For physicians and healthcare providers, the importance of audits, particularly for medical claims cannot be overestimated. Generally, there are two major areas where claims audits present better medical operations practices. First, the audits of operations within your practice also termed as self-audit, is used to determine grey areas, areas where mistakes are being made and areas where improvements can be made to drive significant difference. The other is the audit of the claims administrator.
In the absence of proper management, medical claims can be very costly and complicated. It can even go as far as damaging business reputation. Irrespective of the area being explored by the audit, an audit process generally:
• Locates errors made in medical billing
• Proffers solutions for improving recovery opportunities and
• Ensures that a medical establishment and practice is in tune with the latest compliance guides and regulation that govern medical claims
There are also many other benefits of medical audit claims.
The medical administrator audit claims highlighted above is an independent audit that aims to identify discrepancies in both lost monetary opportunities and adherence to regulations. It is an audit that show how your claims are being handled by the claims administrator and a string reiteration of your commitment to being frugal with every penny being spent as well as ensuring that it is being spent as it should.
This audit is very important as the centers for Medicare and Medicaid services has reported that as many as 12.7 percent of Medicare fee-for-service claims have errors. No matter the size of your medical practice and number of employees, audits serve a great purpose.
To remain thorough, audits should also not be done once but slated for a routine check in order to improve the medical claims process over a longer span of time.
Such audits can be a Random Sample Audit, Hybrid or Comprehensive audit. The extended benefits of a self-audit also include:
• Preventing and lowering the chances of improper payments
• Ensuring the accurate submission of claims
• Improving patient care
• Lowering the need for an external audit
• Reiterating the need for corrupt-free practices within the staff and organization as a whole
Self-audits require thorough examinations of the claims process within your organization and your employed medical practices, it also helps you to make the best evaluation of areas of “risk” that are most susceptible to errors.