Medical Coding Audits – Absolutely Vital for Every Medical Practice

Physicians are very often so stressed out with seeing an increasing number of patients, providing medical services and appropriate follow-ups that they hardly get any time to see to the coding and billing processes themselves. Practices may have in-house staff whose hands may be full with other tasks. Documenting the medical records, carrying out the coding and billing opportunely, and submitting the claims to insurers are however, all very important from the point of view of the revenue inflow to the practice.

Either physicians themselves have to oversee the coding and billing patterns of their practice, or get a medical billing company to do the same before the actual claim submission. Medical bills containing missing or incorrect information usually do not get paid, thus having a negative impact on the practice’s financial condition.

Other coding errors include undercoding and overcoding – the former when the codes assigned do not capture the complexity of the service provided; and the latter when the codes report a more complex procedure than what was actually provided. Both undercoding and overcoding can prevent proper reimbursement and even trigger an audit from the payer. This can be avoided if the medical practice avails of the services of a medical billing company to carry out a medical coding audit to identify any pitfalls in the in-house medical coding process.

Medical Coding Audit – What It Involves

Medical coding audit involves the review of a provider by an external agency such as a medical billing company that has expertise in the provider’s specialty. Such a review will be unbiased and provide a clear idea regarding the practice’s coding standards, accuracy and compliance with all applicable rules and regulations. The audit will bring to light errors and misunderstandings if any, regarding coding and ensure that the physician practice incorporates all the latest coding updates and rules.

A large majority of the claim denials and lower reimbursement result from inaccurate coding and common misconceptions coders have. These can be easily identified at the time of the audit. Coding audits by an efficient medical billing and coding company can also help identify errors or missing information in the medical records on the basis of which the coding is done. This means that the physicians will get a cue to improve the quality of their medical records, thereby giving clearer information to the coder so that only the correct codes are used. Moreover, clarity in medical records is also important with regard to providing better quality patient care.

Be Prepared for RAC Audits

A practice that has a regular medical coding auditing system in place is well prepared for any RAC audit. RACs are recovery audit contractors that are employed by the CMS (Centers for Medicare and Medicaid Services) to identify overpayments and reimburse those to Medicare. They also identify underpayments if any. The RACs receive a percentage of what they recover in overpayments and are therefore rather ruthless in their audits. Hospitals, physicians, home health agencies and durable medical equipment providers are all subject to RAC audits. According to the RAC, overpayments and underpayments are considered improper payments. These include payments for services that are not covered such as those that are not medically necessary, services that are incorrectly coded, and duplicate services.

With a medical billing and coding company providing medical coding audits for you, you will already be aware of any errors or inconsistencies prevalent in your practice and correct them well ahead of an impending RAC audit. You stand to benefit in terms of time, money and reputation. The best thing about having an audit done regularly is that you can also identify underpayments if any, and proceed to claim the due reimbursement. Regular reports given by your partnering medical billing company will help you improve your practice’s performance.