Healthcare Audits

Top 4 Reasons Why Audits Are a Necessary

17th, Feb 2023

Top 4 Reasons Why Audits Are a Necessary

Medical Billing is one of the most convoluted tasks associated with the revenue cycle of healthcare venturesThe 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 mechanismThe 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 facilitiesWithout regular audits, a healthcare organization is a sitting duck for eventualities like claims rejections, life insurance fraud, and worse still non-compliance suits.

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

Audits - Importance
  1. 1. Audits help catch billing mistakes that could cost you a quite a bit of moneyIn June of 2017, a cancer center in New York narrowly escaped a massive cut in Medicare reimbursement as a result of erroneous codingBy entering a wrong value modifier while coding, the clerical staff made a mistake that could have left the cancer center poorer by 250,000 dollarsAnother 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 programsRegular 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. 2. Audits keep your organization compliant with the latest legal requirementsThe 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 timesAn internal or external audit team is usually responsible for keeping abreast with the latest norms and ensuring that you are in line with them. 

  2. 3. Audits help pinpoint areas of improvementEvery process that has been running for some time has scope for improvementAn audit is very useful in identifying shortcomings in areas like medical record documentation, coding, and claims submissionThe 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. 

  2. 4. Audits help prevent unnecessary legal hassle and loss of reputationUnintentional mistakes committed by your staff may lead to cost-intensive legal investigations that may also tarnish your image as a trustworthy enterpriseIt 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. 


Read more: Strategy to Reform Traditional Revenue Cycle Management in Healthcare | Mirra HC

Mirra Healthcare is a third-party administrator 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 and utilize the services in their Medicare in a Box solution, get in touch with us.

Advantages of healthcare audits
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"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans.

Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline.

We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

NANCY GAREAUCEO of Ultimate Health Plans

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