Most Common and Effective Types of Medical Audits in Clinical Lab Billing

September 20, 2021, bestturtlebeach

In addition to this, regular medical audits have become another important aspect of a successful business. But unfortunately, the majority of clinical practitioners overlook this aspect. They never come to know the areas of improvement and the reasons for unpredictable revenue loss. A medical billing audit is a systematic procedure, in which all the medical documents are being deeply analysed to ensure a high level of accuracy.

As a result, auditors successfully uncover the red flags in the entire clinical billing process from patients’ scheduling to revenue collections. In this way, you become able to eliminate all the inefficiencies and can save your healthcare practice from financial loss. The careful examination of all the health records, medical claims, medical coding to ensure effectiveness and reliability can grow your medical practice like never before.

The primary objectives of the clinical lab billing audit are:

1: Review the quality of the clinical care patients received at your practice.
2: Identify the medical coding and billing errors. That led to the claim denials.
3: To make sure that whether or not your healthcare organization is compliant with the rules and regulations established by the regulatory bodies.
4: Identifying false claims and billing frauds.
5: Optimize revenue cycle management.
6: Ensure clinical practitioners are not losing revenue and getting complete reimbursements.

You can build an internal auditing department or hire external auditors _depending on the budget and the resources of the healthcare providers. Additionally, here are the following types of medical audits in clinical billing.

Random Audit
It is the most commonly used audit technique. In which auditors randomly select 200 to 300 medical claims out of millions. Then these claims are being compared with the relevant data and regulations to identify their accuracy and effectiveness.

The basic purpose of the random type is to take an overall glimpse of the clinical practice in terms of both financial as well as an overall success. It’s pertinent to mention here that this type of analysis is done on an ad-hoc basis. Which offers a clear picture of the efficiency of the clinical lab billing and the entire operations of a healthcare practice.
Comprehensive Audit
This approach is totally contrasted to random auditing. During this process, auditors review and examine all areas of a practice’s financial and economic activities. In this process, samples of medical claims are being submitted in two ways: electronic and manual. A complete inspection of the health records, medical documents and billing data enables healthcare providers to uncover all the inefficiencies and implement advanced clinical billing solutions to eliminate the inefficiencies.

Hybrid Audit
This type of audit is more accurate, which is a mixture of both comprehensive and random audits. The auditors select samples for both random and in-depth inspections at the same time. Hybrid audits provide better insights into revenue collections management and particularly medical claims. Such audits help practitioners pave a way to recover the lost money and increase the chances of compliance with the feral law and rules.

Steps Involved in Medical Audit
Medical auditing involves a systematic procedure that usually consists of the following steps:

1: Planning of medical record audit
2: Choosing the type of audit.
3: Determining audit scope.
4: Determining and collecting sample size.
5: Selecting audit tools.
6: Locating documentation.
7: Conducting the audit.
8: Analyzing finding
9: Creating comprehensive reports of findings and analysis.
 

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