AUDITING

Medical auditing entails conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and hopefully liability-free operation.

There are many reasons to perform medical audits:

• To determine outliers before large payers find them in their claims software and request an internal audit be done.
• To protect against fraudulent claims and billing activity
• To reveal whether there is variation from national averages due to inappropriate coding, insufficient documentation, or lost revenue.
• To help identify and correct problem areas before insurance or government payers challenge inappropriate coding
• To help prevent governmental investigational auditors like recovery audit contractors (RACs) or zone program integrity contractors (ZPICs) from knocking at your door
• To remedy undercoding, bad unbundling habits, and code overuse and to bill appropriately for documented procedures
• To identify reimbursement deficiencies and opportunities for appropriate reimbursement.
• To stop the use of outdated or incorrect codes for procedures
• To verify ICD-10-CM and electronic health record (EHR) meaningful use readiness