Medical Auditing

Have you found yourself thinking of ways to improve your healthcare organization? Updating your clinical documentation through medical auditing is the best way for improvement. An audit assists in detecting incorrect coding practices and it could be considered by federal agencies when questioning if steps were taken to avoid and detect fraud and abuse.

What Is Medical Auditing?

Medical auditing, like all audits, is the process of examining and reviewing documents and records to ensure accuracy. Medical auditing takes it a step further and examines medical records to ensure that doctors and medical facilities are in compliance with the rules and regulations of the medical field.

Why perform medical auditing?

Medical auditing involves conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are managing an efficient and clean operation. “Audits are performed not only to ensure compliance but to make sure there is no missed revenue for the provider,” says Lindsey Wingate, Merem Healthcare Solution’s Vice President of Operations. There are several reasons to perform medical audits. Auditing can help protect against fraudulent claims and billing activity, identify problems before challenged with inappropriate coding, identify opportunity for reimbursement, and recognize the use of incorrect codes, just to name a few.

“In my experience, it takes specialized and certified staff to know all the rules and regulations for billing different specialties. When performing an audit for a practice, more often than not I find that charges are being missed due to a lack of knowledge in CPT, AMA, and CMS guidelines,” Wingate explains.

Medical auditing can provide areas of improvement for your coding staff. Even a well-trained staff must be checked, therefore every practice should have an audit performed annually. An audit can recognize under coding, bad unbundling habits, and code overuse. Coding staff will then be able to bill appropriately for documented procedures.

How can we help?

MEREM Health specializes in auditing and can provide education, consultation, reports, and recommendations for improvement. The feedback and recommendations provided by our external auditors are valuable to the improvement of each practice.

Contact Merem Health today to find out how our auditing services will provide support for your practice!