What could I gain from doing an audit? GOALS

The results from any audit are measured against industry benchmarks. If you are struggling to meet or keep up with these standards, a billing and coding audit should be performed in order to help you understand the key areas where your clinical operations are weak and help you to identify priorities and set goals toward making improvements that impact your revenue cycle.

At MEREM Healthcare Solutions, we call these standards, Industry Benchmarks, and it is our mission that all of our clients meet and exceed industry benchmarks.

What is a REVENUE CYCLE AUDIT?

A practice operation review tool used over a period of time to help you improve your current revenue process. We believe that routine, internal audits of your billing and coding processes are necessary. Every time an audit cycle is completed, there should be further improvement in patient care.

WHAT ARE INDICATORS THAT IT’S TIME FOR A REVENUE CYCLE AUDIT?

Is your practice losing money? – An audit will help you identify revenue loss and set goals focused on profit potential.

How quickly are your claims being followed up upon initial denial? – Efforts to reduce claim denials should begin with a revenue cycle audit to help you identify the source of denial trends.

Are you confident in your in-house/outsourced coding accuracy? – Coding services are the life-blood of your practice. That is how the services you provide are transformed into billable revenue.

A complete Revenue Cycle Audit includes:

• Coding accuracy audit
• Billing and accounts receivable audit
• Industry Benchmark Comparison for your individual practice

Conducting a revenue cycle audit in-house may take away from your daily responsibilities, and be a daunting task. Considering an outsourced solution for conducting your audit will help you stay on track and focused on continually improving your processes.

Whether you currently handle your billing and coding in-house or outsource to another company, MEREM Healthcare Solutions can provide you with an unbiased industry comparison and revenue cycle audit report to assist physicians and practice managers with improving their practice performance. Our audit results are always kept confidential for our client’s internal use only.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.
We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.
Please check out our other blog posts, or contact us to learn more.

The post Auditing With NO Fear, NO Frustration and NO Faults appeared first on MEREM Health.

Coding services are the life-blood of your practice. That is how the services you provide are transformed into billable revenue. It takes a knowledgeable and experienced coding staff to maximize your billed charges while maintaining strict compliance with CMS and CCI guidelines.

Coders are trained to identify noncompliance and fraud. Part of a coder’s job is to have sound knowledge in detecting ambiguous or suspicious documentation that could lead to fraud as a false claim if not detected before being submitted to insurance and being paid.

Fraud, in regard to medical coding, is when a false claim misrepresenting the facts is intentionally submitted to insurance in order to receive payment.

Examples of Financial Fraud are:

• Billing for procedures that were never done
• Knowingly billing for services at a different level than what was performed
• Falsifying information in the medical record to satisfy the medical necessity

“You can’t code what is not there” – Meredith Tibbs, Medical Coder at MEREM Healthcare Solutions

Abuse happens when patients are treated with services that are not medically necessary

Examples of Financial Abuse are:

• Billing for medical services that are unnecessary
• Upcoding and Unbundling
• Overcharging for supplies and services

Common terms of Fraud and Abuse in the coding world are:

Upcoding:

Reporting a higher level of service than what is supported in the dictation

Unbundling:

Reporting more CPT (procedure) codes than necessary to increase payment

• Some higher paying procedure codes include smaller procedures in their code descriptions, so you can’t code both. You would only bill the one code that includes both procedures in the description.
• It is very important for a coder to be familiar with these codes and stay updated when these change because they frequently do change and update these codes.

Medical Necessity:

• The doctor must have a legitimate medical reason to perform tests and procedures
• There are certain diagnosis deemed necessary for medical necessity attached to certain procedures. These have to be documented, you can’t make these up to satisfy the medical necessity

It is VERY important as a coder to be knowledgeable and confident in their field, so they are able to detect any potential risks that could negatively impact the facility and/or physician they work for as well as educate the people around them that don’t know.

“Staying up to date through compliance training either on their own or through their organization is of the utmost importance. Coders work too hard to earn their certifications and, in this field, honesty is ALWAYS the best policy.” -Meredith Tibbs, Medical Coder, MEREM Healthcare Solutions

Auditing can provide areas for 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.

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!  

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.  We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

The post How Coders Can Help Prevent Healthcare Fraud and Abuse appeared first on MEREM Health.