Medical Billing Audit Checklist: Expert Tips

The world of medical billing is complex, and suffice it say, attention to detail is non-negotiable. A medical billing audit checklist is a great tool to use to help ensure that your medical billing department is adhering to regulations and working effectively to prevent mistakes. 

However, mistakes are inevitable when working with a high volume of data by hand, which is why automation software is a must-have solution. Let’s uncover what a medical billing audit is and how to protect your business from costly and damaging errors.

Coming Up

What is a Medical Billing Audit?

What are the Benefits of a Medical Billing Audit Checklist?

How to Prepare for a Medical Billing Audit?

What are the Steps for a Medical Billing Audit Checklist?

What are the Key Components of a Medical Billing Audit Checklist?

How to Implement a Medical Billing Audit Checklist?

Final Thoughts

What is a Medical Billing Audit?

A medical billing audit is a review of medical bills to make sure that everything has been entered and billed correctly. 

The medical billing audit process: 

• Matches patient records against bills to check the information is in alignment 
• Confirms that laws are being followed 
• Aids in helping medical providers avoid mistakes 
• Helps pinpoint areas in which staff may need extra training 
• Finds errors that need fixing 

A medical billing audit is performed to double check that clinics and medical providers are submitting patient bills properly and fairly. 

What are the Benefits of a Medical Billing Audit Checklist?

Having a medical billing audit checklist can prove to be extremely beneficial for medical businesses. It is so useful because it serves to: 

1. Ensure Compliance

The medical industry is highly regulated, and for good reason. Not only is it regulated when it comes to patient health and care, but it is also closely overseen in terms of billing and finances. Proper billing goes hand-in-hand with remaining compliant. 

2. Detect Errors

Errors are inevitable, so a medical billing audit checklist serves as a safeguard to prevent them from growing larger or moving forward. 

3. Identify Process Improvement

Since medical billing is a timely endeavor, especially when completed without the aid of finance automation software, a medical billing audit checklist can showcase where improvements need to be made. 

Finance automation software can be leveraged to automate all of your key finance functions, including: reconciliation, expense management, regulatory reporting, and more. 

Additionally, beyond process automation, finance automation software collects and centralizes data, provides key insights and analytics, and provides businesses with the information they need to operate with agility. 

By using such a solution, you’re able to prevent manual data entry, streamline processes, and customize dashboards to maintain internal oversight. 

4. Prevent Fraud

Fraud is found when you follow the money trail, which is what a medical billing audit checklist helps you to do. 

5. Optimize Revenues

By overseeing medical billing, it’s possible to see where most of your business’ revenue comes from. Knowing this information can assist in decision making to boost profits. 

How to Prepare for a Medical Billing Audit?

A medical billing audit may sound overwhelming because of the obvious word, “audit,” but it can go smoother if you prepare properly. 

Here are our top recommendations to do so:

1. Set Clear Policies 

Conducting internal audits on a regular basis can greatly relieve any stress associated with an external audit. To do so, clearly communicate with your team as to when to execute internal audits and what policies to follow. 

2. Educate about Documentation

Healthcare workers are often bogged down with recordkeeping, even though there are technological solutions to handle the nitty gritty details. 

As such, it’s paramount to educate your staff how to manage documentation. It’s of course of utmost importance to keep data up-to-date and accurate at all times; data process automation helps! 

3. Leverage Technology 

EHR and automated billing software prove to be a gamechanger. Integrated technology solutions ensure that your data is always secure, up-to-date, and correct. Medical billing teams can then automate the medical billing audit process to save time and improve efficiency. 

Additionally, when dealing with any billing checklist, a finance automation solution is a must-have! You will never have to rely on manual data entry again. Instead, the finance automation technology will centralize and secure your most important data, perform critical processes in less time without errors, and enable accessibility from anywhere.

What are the Steps for a Medical Billing Audit Checklist?

Wondering how to carry out a medical billing audit checklist and work through the process? These are the steps to follow:

1. Define the Scope

Review your current medical records to define what will be reviewed in the upcoming audit. It’s a good idea to determine the number of billers, payers, coders, and providers to know what kind of audit experts will be needed to conduct the medical billing audit checklist. 

2. Choose the Team

You’ll probably wish to combine internal and external audits. External auditors are third-party evaluators who remain impartial on the job. 

3. Assign the Jobs

With the scope defined and your team of auditors ready to work, it’s time to choose your strategy. For example, you may want to divide up a certain number of records per provider and payee to each auditor. 

4. Review Documentation

The meat and potatoes of the medical billing audit occurs when auditors review billing reports, codes, records, and charges. 

They should be checking to see that the: institution remained in compliance, the documented services are assigned to the right patients, the CPT codes are reimbursed according to contracts, and that charges are correct, etc. 

5. Audit Findings 

If issues were detected, it’s up to you to remedy them in a timely manner. If you disagree with the audit findings, you have a set period of time to contest them. 

What are the Key Components of a Medical Billing Audit Checklist?

As we started off with, a medical billing audit checklist is a handy tool to use to move through your medical billing audit process without the fear of something important slipping through the cracks. 

Having a clear list as to what you must review is like having a grocery list prepared when you go to the store– you’re unlikely to forget a key ingredient. 

For your medical billing audit checklist, these are the main ingredients:

1. Patient Data

Everything starts with the patient, so it’s of primary importance that the patient’s information is 100% accurate. Patient details, such as: name, date of birth, insurance information, and the like must be recorded correctly. If not, it can result in denied claims or delayed payments. 

2. Charges and Coding

Charge capture and coding review is another critical aspect of medical billing. Coding is used to describe the services that were rendered.

These codes are what determines the cost of service, and ultimately, what a patient must pay to the provider. Medical billers must have a strong knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes to complete their work. 

3. Claims Submission

Healthcare billing relies on proper and timely claims submission. The audit checklist reviews each component of the claim submission process to make sure that all relevant documentation is included. This way, providers can reduce mistakes and promote being paid on time. 

4. Payer Policy Compliance

Insurance companies all have their own set of policies and procedures. These policies are likely to change over time, so a review of payer policies makes sure that submissions are in line with payer requirements. 

5. Documentation Review

An effective medical billing audit cannot be complete without documentation review. Auditors must check that the services that were billed were medically necessary. 

6. Payment Posting

Payment posting is done by reconciling payments against billed amounts. This is to make sure that patient accounts accurately reflect what is owed. 

It’s vital for businesses because it directly affects revenue recognition and financial health, so it cannot be understated how much accuracy matters here. Reconciliation software can streamline the transaction matching process so that manual mistakes may be avoided. 

7. Denial Management

Anyone who works in medical billing knows the pain of a denied claim. It’s optimal to be able to review and rectify denied claims as soon as possible in order to get paid in a timely manner. 

The audit checklist reviews the denial management process to check that the appeals process is efficient. If not, suggestions can be made. 

8. Revenue Cycle Management

The revenue cycle begins with onboarding a new patient and is fulfilled when a patient pays their bills. Auditors look to see that the overall journey is smooth and free of bottlenecks. 

9. Staff Training

No matter how much experience that your medical billing staff possesses, it’s always beneficial to continue with training and education. 

Coding guidelines and regulations often change, so it’s best if everyone on the team is updated with the latest policies and regulations. By doing so, you can internally control your level of compliance and work to mitigate risks. 

How to Implement a Medical Billing Audit Checklist?

When you’re ready to get started and implement your very own medical billing audit checklist, remember these best practices:

• Define the scope of the audit 
• Choose a team that is experienced 
• Train your audit team according to billing regulations and technologies, as well as how you wish for them to communicate and document finding 
• Make use of finance automation software and data analytics tools to streamline processes 
• Consistently review the audit process and make any necessary adjustments to improve upon it over time 
• Have quality control and internal control measures in place 
• Share the medical billing audit checklist with auditors! 

Final Thoughts

A medical billing audit checklist is like a blueprint for your medical audit billing requirements. By devising your own checklist and defining a clear medical billing audit process, you can reduce confusion, enhance effectiveness, and ultimately, do everything in your business’ favor to get paid what you are owed in a timely manner. 

Most importantly, the top of mind consideration for any billing checklist should be the use of finance automation software. By using this technology, your business can run process 85x faster with 90% fewer errors, collaborate across teams, transform data into useful insights, and ensure compliance. 

Plus, your finance and accounting teams no longer have to be bogged down conducting manual and repetitive tasks. Instead, they can focus on adding value and providing strategy for your organization.