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How to Prevent Audits from Payer End

Medical practice has many important aspects, but medical billing happens to be a crucial aspect. It controls all the flow of revenue, and this alone can determine the success of the medical practice.

All medical practitioners are cautious about the revenue cycle, and how vital it is to process the claims on time. But, not many are aware that audits from payer sources too should be prevented. Payer sources meticulously look for errors in coding and medical billing.

If you think, they do happen always, and then you need to know being a little vigilant can help a lot.

1. Bring in Experts

Medical coding is an intricate business, and things can go wrong at various places. The medical coders are certified and trained personnel, still chances to land up in errors are many. Investing in an expert or experienced coder can help.

However, do not let the resource do the coding, but oversee the process. An extra eye helps. You need not wait for the claims to get rejected and then get paid after months, instead spend a little over here.

An alternate option is to outsource the process of coding and medical billing, and these professionals take care of it.

2. Provide all Documents

MRIs, physical therapies, and sleep tests are the areas where the payers feel that the medical professionals focus for no reason.

Send all the necessary documents with the claim, and explain in detail why these were necessary to go about the treatment process.

3. Don’t forget the audit sheets

Every payer can check variety of things in the claims. Fortunately, audit sheets of payers are available in their corresponding sites.

Download the copy and find what the payer audits for. This helps in finding the errors in your claims, and correcting them even before the payer finds them.

4. Educate your staff

Explain to your staff why audits can cause a problem. Ensure all coding and billing, are done on time, instead of rushing everything together.

You also should let them know what can trigger the audit from the payer end. See that they are trained on all updates on coding frequently.

You should also ensure that the employees are recruited for coding and billing specifically. Don’t rely on the front desk staff to carry out these tasks.

If you think that in-house coders and medical billing executives would not find enough job, or can mean lots of investment from your end, then outsource the process.

5. Templates can Trigger Audits

Documentation of the treatment should be patient-specific. While you can find templates coming handy, do not rely on them for each patient.

Payers check for similarities in the documentation process. When the same template or words keep repeating in all the claims, then it obviously triggers audits.

Copy and paste of the documents never helps but lands in a red flag.

6. What is your E&M; coding?

If you are over coding for the evaluation and management services compared with your peers, you are in trouble.

Find the national average of E&M coding and where you are placed to avoid audits.

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