Conduct systematic Medical Billing Performance Audits to keep your Medical Practice Healthy!

What is a medical billing performance audit and why is it important?

You travel to work daily and every day your car’s engine makes strange noise. A day comes when it finally stops working. If you had taken the car for a mechanical diagnosis, the issue could have been corrected without it becoming a problem. Same goes for a business, no matter what industry.

A Medical Practice comprises of many moving parts i.e., medical billers and coders, insurance providers, nurses, administrative staff, doctors etc. Issue can easily arise in the workflows, medical billing processes or operative systems. To avoid these menial issues becoming major problems, systematic performance audits are important.

A Medical Billing Audit therefore is a Medical Billing performance analysis that helps identify hiccups in the Practice Management workflows and Medical Billing processes. It can be an internal one (done by a hired medical billing consultant) or an external one (done by third party medical billing company).

What is assessed in a Medical Billing Audit?

A Medical Billing performance audit focuses on gaps in Practice Management workflows and Medical Billing processes in a Medical Practice. Have a look at the points below to get a detailed idea of what the audit should cover:

  • Revenue Integrity and lost opportunity cost
  • Provider and staff inefficiencies
  • Workflows and process improvements
  • Revenue cycle management performance
  • Insurance contracts and fee schedules
  • Compliance documentations

A medical billing performance audit is usually quiet thorough covering all the phases in the claim life cycle – from scheduling, eligibility to denial management practices. Through this, the areas that require improvement are highlighted. It protects the practice against heavy losses, fraudulent billing and claim submission that can penalize the practices heavily.

How can a Medical Practice Conduct Self Medical Billing Performance Audit?

Track your practice’s key performance indicators from month to month and year to year to gauge problematic areas. Key performance indicators not just push your practice to perform better but enables comparison against industry standards as well.

Establishing metrics that can be reviewed on consistent basis makes analysis easy and helps sheds light on the gaps responsible for revenue losses.

What key RCM indicators should Medical Practices be tracking?

  • Monthly charges, payments, and adjustments compared to averages and historical data
  • Charge-entry lag times
  • Denial percentage
  • Clean-claim-rate percentage
  • AR aging by date of service
  • Gross-collection percentage
  • Net-collection percentage
  • Days in AR/ Days in AR over 120 Days

A thorough Medical Billing Performance Audit should shed light on problematic areas with suggestions to improve and a road map that can help Medical Practice achieve its full Medical Billing potential. It helps Practice Managers answer questions like:

  • Why isn’t my Practice making more money than it is?
  • Do we have more no-shows than other practices?
  • What processes need to be more effective?
  • Are Patients paying their deductible and co-pays in timely manner?

How can AltuMED help?

AltuMED is an experienced Medical Billing and Practice Management Company that provide its Medical Practices with systematic and effective Medical Billing Performance Audits. We believe in working with our practices to fulfill our aim of providing “value for all” in terms of healthcare as well as monetary benefits. Contact us to book yourself a Performance Audit straight away.

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