Medical Billing Audit Archives - InfoHub Fri, 22 Jul 2022 07:21:43 +0000 en-US hourly 1 Medical Billing Audit Archives - InfoHub 32 32 Impact Of AR Audits on Your Practice Tue, 05 Jul 2022 12:18:54 +0000 Are there loopholes in your AR process? Is your practice facing revenue losses? It goes without saying that unpaid accounts receivable stifle cash flow and rob you of the funds you need to invest in expansion prospects, purchase new machinery, and recruit staff, and that’s just the tip of the iceberg.

Other unintended effects of a poor accounts receivable management process include:

• Missed follow-ups on past-due invoices

• Writing down outstanding receivables as bad debt

• Errors on bills and invoices

• Incorrect payment allocation

All of these factors result in decreased cash flow, which may require you to scale back operations and production. As a result, the company can fall short of its revenue goals as its rivals expand. If you can spot the barriers to effective AR management, you can get through them.

Some of the common AR challenges that hinder practices are –

Unorganized Ledger

Knowing how much money you are owed, who it belongs to, and when they are required to pay you, is dependent upon keeping your invoices organised. For proper AR management, having a system that enables you to have total visibility is essential. Inefficient accounts receivable management can result in a cash-flow deficit.

Lack of Communication with Patients

At the start of every patient relationship, it is imperative to establish communication lines and contact points because this will help you get payments on schedule. To ensure a healthy information flow, we advise keeping note of all the times and channels you have spoken with your customers.

Inefficient Policies

The worst thing we can do is undermine the business by unworkable AR management procedures. Someone, sometimes not on the finance team, can add a new payment option or offer a credit incentive without taking into account how it would affect the accounts receivable procedure.

However, it’s a sad fact that not everyone will be a good fit for your goods or services. You can distinguish between those who would make excellent customers, and people who wouldn’t with the help of a well-designed credit policy. As a result, reviewing and streamlining your AR policies is frequently worthwhile.

Benefits of an Audit

The FPR is improved by the insights obtained through audits (First Pass Ratio). Understanding the different audit standards that apply to each provider setting will help providers choose the appropriate solutions for their particular requirements.

Optimised AR Process

A finance staff can improve a client relationship in a variety of various ways without hindering cash flow. Examples include:

• Providing “Zero-Fee” payment choices for chosen payment methods.

• Implementing a service charge to deter undesired payment methods.

• Automating reconciliation, follow-ups, and invoice mailing.

• Only accepting digital payments.

• Cutting costs, choose flat-rate payment processing solutions.

• Saved payment options by customers.

• Giving customers automated, verified receipts.

Increased Coding Efficiency

Coding staff benefit from billing audits because they can identify and address important problems well before insurance companies express concerns about inappropriate coding. With enhanced billing and coding procedures, conducting an AR audit helps streamline and expedite medical billing process.

Improved Administrative Process

Audits help the administrative staff by guaranteeing that claims are legitimate, accurate, and filed correctly. Medical claims audits safeguard the practice from erroneous billing and claims. Practices may successfully check for ICD-10-CM and Meaningful Use compliance. When they have an internal check and balance system in place, it will enhance the entire process. Medical billing audits are used to reduce or eliminate payment errors. Additionally, the practice gains from expedited file processing, decreased inappropriate payments, and improved claim payment.

Improved Patient Care

The entire medical practice focuses on the standard of care provided by measuring and observing services and practices and training doctors on how to give positive medical experiences to their patients. You can manage your business successfully and spend more time with your patients when the workflow for medical billing and claims processing is improved. Patients get better patient outcomes and the revenue cycle functions more efficiently when they have a better patient experience.

Info Hub Services comes with expertise in accounts receivable services along with medical billing and coding. Our highly qualified team of A/R experts has experience working with many insurance providers and is knowledgeable about all of their policies. We make sure that our clients receive their compensation for the services they have rendered without any problems.

How to Measure Your Billing Process and Its Effectiveness Wed, 29 Jun 2022 13:25:00 +0000

The success of your medical practice depends on carefully monitoring your practice’s financial performance while offering excellent patient care. The process of medical billing and coding is an intricate and a tedious one, requiring expertise to conduct the same. You can make sure the practice is getting paid by routinely checking your medical billing data. Medical billing metrics can help you evaluate and put into effect best practices that are appropriate for your clinic. Key performance indicators (KPIs) for medical billing assist clinics in measuring their revenue cycle and billing, and offer suggestions for boosting collections. Your medical billing information can be analyzed in a variety of ways however, the following pointers can help measure your billing process and its effectiveness –

Days in A/R

Knowing how long it usually takes between seeing a patient and getting paid allows you to determine whether your team is submitting claims to payers in a timely manner. Additionally, you’ll know how much money you need to preserve in the bank to cover running costs prior to reimbursements.

Accounts receivable delays aren’t always your staff’s fault because payers process claims at their own leisure. In any case, it’s crucial to prevent your claims from being in AR for weeks or even months. To make sure that no claims are overlooked, it is essential to keep track of days in AR that are longer than the required 60 days.

Collections Per Visit

Which operations are most crucial to your income overall? It can be helpful to plan your appointments around the areas that generate the most cash for your practice by tracking your collections per visit on a month-on-month basis, and comparing the rates to the kind of appointments you accepted each time.

First Pass Resolution Rate (FPRR)

The percentage of claims that are paid following a single submission is known as your first pass resolution rate (FPRR). You may determine the efficiency of your revenue cycle management (RCM) process using this statistic. If your clinic has trouble increasing patient retention rates (FPRR), concentrate on insurance verification, billing, and coding to improve RCM.

FPRR is the ratio of the number of first-pass claims paid divided by total number of claims submitted during a specific time period

Gross Collection Rate

A high gross collection rate (GCR) demonstrates how well your practice is performing with collections and how closely your fees correspond to the payer’s rates. A higher rate does not, however, automatically imply higher financial success for your practice. Due to the fact that every practice establishes a different charge schedule, it is advisable to monitor this indicator internally as opposed to comparing it to industry benchmarks or other practices.

Net Collection Rate

This simple-to-calculate indicator shows how successfully your practice is obtaining the compensation you are entitled to. To determine how much revenue is lost as a result of things like uncollectible debt or other non-contractual modifications, practices calculate their NCR. Comparing practices with similar specialties, locations, and clinical staff is possible using this statistic. If you see your net collection rate lower than 90-100%, you must consider a billing audit. 

Contractual Variation

The difference between what you are paid and what you agreed to with your payers is known as a contractual variation. This may be impacted, among other things, by how your biller files the claim. A claim that was submitted incorrectly may still be paid, but there is a potential that it may be paid insufficiently. Analytics for your practice should be able to show you instances where the amount you were expecting to be paid under the fee schedule was less than what you actually got from the insurance provider.

Year End Reviews

Metrics collected on a daily, weekly, or even monthly basis cannot give decision-makers enough visibility. Generating quarterly AR reports can give your clinic the knowledge it needs to adopt medical billing processes more effectively. The full performance evaluation for your practice can be obtained from doing year-end evaluations of all the aforementioned measures in addition to quarterly reviews. A thorough annual evaluation of all your records can shed light on your procedures and show where accuracy needs to be improved.

Outsourcing medical billing services has evolved into a simplified process with the best cost-saving strategy in today’s changing digital healthcare market. This is the only option for your medical practice if you want to build a solid cash stream. Info Hub, an offshore medical billing company, is one of the leading medical billing service providers and offers the best medical billing and coding services across multiple specialties.

Importance Of Auditing Medical Billing Services. Thu, 17 Feb 2022 11:32:25 +0000 A billing audit is a procedure for determining whether the information in a provider’s health record, as well as appropriate and referenced medical policies, papers, or support services indicated on a provider’s charge, are accurate. Providers undertake such audits either internally or by contracting with an external audit company. (These audits are frequently referred to as revenue recovery audits and can be conducted retrospectively or concurrently.) In addition, third-party payers also undertake billing audits through their personnel or agents. (Chart audit or charge review are other terms for the same thing.)

Medical billing auditing is a systematic procedure for examining and evaluating clinical documentation’s usefulness and dependability. This method meticulously examines all of the practice’s health records and medical billing data supplied to payers to ensure that the procedure detects, monitors, and corrects any improper billing practices. Because billing impacts the bottom line, recognizing potential compliance issues is critical.

The frequency with which medical coding is audited is determined by various criteria, including the organization’s size, personnel turnover, and regulatory revisions. Experts recommend performing an external code audit at least once a year, but many healthcare facilities opt for monthly audits to get the most benefit.

Monthly coding audits enable healthcare businesses to detect problems more frequently, recoup more income, and correct errors that result in revenue loss. In addition, medical coders can use the information gathered from monthly audits to stay up to date on the newest regulatory requirements and avoid common mistakes. Monthly audit reports might also be helpful in onboarding new coders.

The medical billing audit can be divided into two broad types: internal medical billing audit and external medical billing audit.

Internal auditing is carried out by a group of people from within the organization. Larger companies may have a dedicated internal audit team, which gives them the advantage of undertaking audits regularly. In addition, auditing regularly provides the business with data that enables continual process and accuracy improvement.

External audits can be an excellent alternative for a small, busy firm where they hire medical billing companies. They provide insight that removes conflicts of interest and detects upcoding without consideration for revenue impact, something that even the most well-intentioned internal auditors may overlook. There’s also the advantage of recommendations having greater weight when they originate from a third party. On the other hand, external audits aren’t a perfect substitute for internal audits. Even organizations that undertake internal audits regularly should have an impartial, external audit done once a year.

Conducting billing auditing may be a bit tedious, but it has a wide range of benefits for practices in coding, administration, revenue cycle management, among others.

Corrective measures for more accurate medical coding

Billing audits are beneficial to coding personnel because they allow them to discover and resolve issue areas before the government or insurance payers raise objections to incorrect coding. Having someone to rely on to spot mistakes and guide how to fix them boosts coding staff confidence and guarantees that they use the most up-to-date procedure codes. In addition, those conducting the audit will pinpoint areas where staff education and training are required to ensure that proper coding methodology is followed at all times.

Helps the administrative staff to maintain correct records

Billing audits are beneficial to coding personnel because they allow them to discover and resolve issue areas before the government or insurance payers raise objections to incorrect coding. Having someone to rely on to spot mistakes and guide how to fix them boosts coding staff confidence and guarantees that they use the most up-to-date procedure codes. In addition, those conducting the audit will pinpoint areas where staff education and training are required to ensure that proper coding methodology is followed at all times.

Improved Payment Cycles

Medical billing audits aid the administrative staff by ensuring that claims are valid, accurate, and submitted correctly. By fostering a good, stable work environment and a culture of compliance that attracts and maintains outstanding employees, audits set the norm for office staff and save them unneeded frustration. Billing for commonly documented procedures replaces under-coding, code misuse, and incorrect unbundling habits. When policies and processes are established and followed appropriately, the likelihood of an external auditor’s visit is significantly reduced.

Better Experiences for patients

Medical claims audits help to improve patient care in a good way. The focus of the entire practice turns to the quality of care offered through recording and monitoring services and procedures and training physicians on how to provide happy medical experiences to their patients. When patients have a better experience, the revenue cycle runs more smoothly, and patients have better outcomes.

Info Hub is a prominent offshore medical billing company that can assist you in getting the most out of your payments. Medical billing, medical coding, credentialing, and revenue cycle management are all services we offer. Contact us today for a stress-free medical billing and claims experience and increased revenue.

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