• When was the last time we reviewed our process or improved our technology?
• How accurate is our documentation?
• Can we improve

But it doesn’t have to be this way. Our team at MEREM Healthcare Solutions wants you to know how to be as prepared as possible in case your medical practice finds itself in the middle of a CMS audit this year. One of the best ways to avoid a CMS audit is to be prepared at all times, the best way to do so is by conducting internal audits within your medical practice.

When Was the Last Time You Reviewed Your Process?

Every medical practice has its own unique operations “process.” Is your process working for your medical practice as it should? Internal audits can be helpful in identifying areas of improvement such as your practice management software/technology and can highlight challenges within each step of your revenue cycle from documentation and coding, to billing and collections.

Technology is always changing to provide improved accuracy, especially when it comes to medical billing. If your medical practice is still using technology from years ago, then you may face a higher chance of errors in addition to your team being limited in their ability to work as effectively and efficiently as possible thorough streamlined pms processes.

Conducting an internal audit can allow you to see if the time has come to update your medical practice’s “process,” also known as “technology.”

An internal audit can also prevent revenue loss from occurring, as it can point to where issues are happening so that you can identify areas to focus on improving. For example, if your practice is facing a signifacant amount of claim denials due to coding mistakes, it might be better to consider outsourcing your medical billing and coding to a team of experts that have the experience,and ongoing training for coding within your specialty —like us!

If it has been a while since your last internal audit, you might want to conduct one sooner rather than later.

How Accurate Is Your Documentation?

When it comes to a patient health record, there is absolutely no room for error. Not only can it cause harm to the patient, it can also cause your medical practice harm and possible fines if caught while undergoing a CMS audit.

There should be no discrepancies whatsoever when comparing medical information, such as health records, which should be filled out properly throughout the entire process. Every detail is key.

MEREM Healthcare Solutions Is Here to Help!

A lot of concerns that we’ve discussed with potential clients particularly come from Pain Management physicians because they are a high risk for audits and they want to make sure everything is being coded and billed correctly and ethically to keep them off the grid from auditors.

As we explained earlier, one of the best ways to avoid a CMS audit is to be prepared at all times, which includes conducting your own audits within your medical practice. If you are noticing your medical practice is losing money or you do not have 100-percent faith in your team’s coding accuracy, it may be time for an internal audit! We can help you.

At MEREM Healthcare Solutions, you can feel confident that our knowledgeable and experienced team provides the coding accuracy your medical practice needs in order to keep insurance claims correct and get your medical practice paid for services provided.

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid and/or prepare for a CMS audit.

Merem Healthcare Solutions offers services for every step in a practice’s revenue cycle management. We can start from the beginning from credentialing and end with payment posting once an account has been satisfied. We offer a wide range of solutions which include auditing, billing, coding, consulting, credentialing, payment posting, practice management, and pre-collections training. Check us out on our website or feel free to call us to see how. Our customized healthcare solutions can help you run your practice like a well-oiled machine – (205) 329-7519.

The post How Can Your Practice Avoid An Audit? appeared first on MEREM Health.

A practice’s efforts to reduce claim denials should begin with an understanding of its greatest source of denials.

Run a series of denial reports over a period of time (3 weeks, or 3 months) that include:

• denial reasons
• procedure codes reported
• modifiers
• diagnosis codes
• payors

The results can be your greatest asset in identifying the source of denials. You can then sort the reports from each field to determine a particular coding issue and identify the greatest opportunity for your practice to focus on denials improvement.

Pay Attention to Timing

Although often unintentional, timely filing is a leading reason for denied claims. Each payor has their own filing deadlines that range from 90 days to 1 year. Failing to submit a claim within their assigned period will result in rejections that your practice may have to write off.

Even if denials have been reworked and claims adjustments have been resubmitted, the corrected claims must meet the original filing deadlines in order to be approved.

Poor management of claims can be detrimental to the financial health of a practice. Avoiding claims denials should be the responsibility of everyone in the practice. For more information about how MEREM Healthcare Solutions can help you combat claim denials, follow us on LinkedIn and check out future a continuation of this blog in the coming weeks.

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 Step by Step Efforts to Combat Claim Denial appeared first on MEREM Health.