It goes without saying that medical coding and auditing play big roles in the healthcare industry, ultimately being the cornerstone for ensuring your healthcare organization is accurately reimbursed for the services you’ve provided.

However, the healthcare industry is changing all of the time, and the complex and unpredictable nature makes the medical coding and auditing process a lot more difficult than it needs to be.

If you’ve submitted inaccurate coding, you can potentially face a range of serious consequences, such as financial penalties, various legal issues, and perhaps worst of all, compromised patient care.

As a result, it’s imperative that your healthcare practice implements strategies to help improve your overall medical billing process. Throughout this article, we’ll be going over some practical tips you can start putting into practice to help boost the quality of your medical coding audit services.

Common Challenges With Medical Auditing

Firstly, let’s start with what can go wrong. While medical coding and auditing plays a huge role in the healthcare industry, there’s often a few things that can go wrong that hinder how effective your process can be, ultimately slowing you down.

In this section, we’ll talk about what some of these challenges are and how you can compensate for them.

Compliance With Regulations

We mentioned this at the beginning briefly, but healthcare providers can face major issues when it comes to keeping up with new codes and regulations. As the healthcare industry is fairly regulated, you run a few risks each time you fail to comply with new regulations. This can be as bad as facing legal action, receiving costly penalties, or even loss of your medical license in some cases.

Complexity

Moving on, many coders involved in the auditing process can face problems with the sheer complexity of the entire process. With thousands of medical codes and intricate billing procedures, it’s understandable for healthcare providers to make some mistakes along the way. 

However, remember that these errors can easily lead to things like billing discrepancies, claim denials, and even accusations of fraud. In addition, the rise of telehealth and virtual care has introduced a few new challenges into the industry, including the general learning curves that come with switching to virtual visits.

Consequences

There’s no use sugar coating when it comes to how detrimental poor medical auditing practices can be for your business. For example, the Healthcare Financial Management Association conducted a study that demonstrated up to 10% of claims were being denied solely due to coding errors, resulting in a frustrating loss of revenue for practices. 

Furthermore, you always face the consequences of things like fines and exclusion from federal healthcare programs when you’re non-compliant with the latest codes.

Strategies To Improve Medical Auditing

Because of how awkward and time consuming medical coding audits can be, we’ll be discussing a few strategies exploring how to improve your process. Firstly, let’s kick things off with the importance of keeping on top of your medical billing audits.

Why Your Practice Should Implement a Proper Medical Auditing Process

Among a never-ending list of other reasons, ensuring coding accuracy in your clinical documentation is vital for minimizing any errors that could cost your practice money. When you’ve got an efficient system in place for handling medical billing data, it’s a lot easier to identify any of the coding errors that result in potential legal and financial consequences.

Aside from covering your own back, a well-implemented auditing process does wonders for ensuring all your patients receive the quality of care they’ve come to expect from your practice, leading to improved relationships and subsequent revenue.

Best Practices For Medical Auditing

Ongoing Training and Education

Since industry trends and regulations are constantly shifting, it’s crucial that everyone in your medical practice is up to speed on what’s changed and corrects inappropriate billing practices. As the owner, it’s your responsibility to invest in any training/educational programs to ensure everyone knows what they’re doing.

While staying in house is one route you could take, outsourcing the process to an external auditor is another popular option that’s worth taking a look at.

Outsourcing Medical Coding and Auditing to PMN

Have you ever considered an external coding audit to ensure your medical billing process is fully compliant? PMNs medical billing audits cover a lot of ground, from reviewing your coding to analyzing claims, they go the extra mile to ensure compliance.

Their auditor collects clinical records/medical records from your practice and works with a team to thoroughly scrutinize them. In addition, they all use the latest technology and follow standardized coding processes, so you’ll never have to worry about denials or having to chase up payments from patients.

What’s more is that PMN can actually offer training and education to your team directly, so you don’t need to bother hiring any costly in-house staff to take care of this process. If you’re interested in hearing more about what PMN has to offer, consider getting in touch with them today at (949) 215-5055 or by visiting their headquarters in Laguna Hills, Orange County, California!

FAQs

How Technology Is Changing The Medical Auditing Landscape

Technology has revolutionized the healthcare industry in countless ways, and medical auditing is no exception. Advancements in various medical tech are transforming the way medical auditors can collect, analyze, and interpret different types of data.

Ultimately, this makes the whole process a lot faster, allowing auditors to identify potential errors or fraud more quickly and effectively than ever before.

The Future Of Medical Auditing

Looking forward, it’s clear that technology will continue to play a crucial role in the medical auditing landscape. As healthcare systems become increasingly digitized, auditors will need to stay up-to-date with the latest advancements and tools to effectively analyze and interpret data.

This includes the continued integration of AI and machine learning will enable medical auditors to analyze data more quickly and accurately, leading to more effective audits and better patient outcomes.