Audits: 4 Reasons Why They Are A Necessity

Medical Billing is one of the most convoluted tasks associated with the revenue cycle of healthcare ventures.  The intricacies of the coding process and the regulatory restrictions that are forever in a state of flux are factors that contribute heavily to the complexity of the billing mechanism.  The complicated nature of the medical billing procedure makes it easier for discrepancies and errors to occur in the resulting claims. Audits are an essential part of the compliance program established by healthcare facilities.  Without regular audits, a healthcare organization is a sitting duck for eventualities like claims rejections, insurance fraud, and worse still non-compliance suits.

Here are the reasons why regular audits are imperative for the success of your organization:

  1. Audits help catch billing mistakes that could cost you a quite a bit of money.  In June of 2017, a cancer center in New York narrowly escaped a massive cut in Medicare reimbursement as a result of erroneous coding.  By entering a wrong value modifier while coding, the clerical staff made a mistake that could have left the cancer center poorer by 250,000 dollars!  Another hospital, though, was not as lucky. The Memorial Hermann Hospital System in Houston, Texas recently agreed to pay 2 million dollars to the United States to resolve incorrectly billed claims to federal programs.  Regular audits can help you skirt such a fate. Auditors check for consistency and accuracy of coding and make amends where needed before it is too late.

  2. Audits keep your organization compliant with the latest legal requirements.  The billing piece of the healthcare machinery is forever under the scanner. It undergoes the maximum number of regulatory changes, and hence it becomes difficult to keep up with the most current requirements at all times.  An internal or external audit team is usually responsible for keeping abreast with the latest norms and ensuring that you are in line with them.

  3. Audits help pinpoint areas of improvement.  Every process that has been running for some time has scope for improvement.  An audit is very useful in identifying shortcomings in areas like medical record documentation, coding, and claims submission.  The findings of an audit can serve as educational material for those involved in coding and billing to improve working methods as well as provide an idea of what mistakes are most likely to occur and how to avoid them.

  4. Audits help prevent unnecessary legal hassle and loss of reputation.  Unintentional mistakes committed by your staff may lead to cost-intensive legal investigations that may also tarnish your image as a trustworthy enterprise.  It is better to spend time conducting thorough audits that will help you pre-empt problems and find ways to fix them rather than losing time, money and years of good-will to a lengthy federal investigation.

Mirra Health Care is an organization that provides auditing services in the field of medical billing to healthcare facilities like hospitals and private practices.  The auditors at Mirra are amply qualified and experienced in conducting effective audits that will keep you out of harm’s way. These auditors will also provide keen insights based on the findings of their audits that can help you smoothen existing processes and avert any prospective trouble.  For more information on how you can partner with Mirra, get in touch with us -

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