Medical practices that work with insurance providers always need to be conscious of the accuracy of claims that they are submitting. If you suddenly receive an audit notification from one of the companies that you work with, it can be panic-inducing if you aren’t sure whether or not your records are accurate. Here’s what every medical practice needs to know about the benefits of conducting a medical insurance audit.
What Is a Medical Insurance Audit?
Audits are often conducted by insurance companies who want to ensure that practices are submitting claims that are accurate and documented properly. Most audit requests will ask for a representative sample of internal documentation, records and other items that indicate whether or not you are doing things properly. Practices can choose to conduct their own medical insurance audit internally to proactively prepare and catch problems before an insurance company requests an audit.
What Are Some of the Reasons a Company Might Be Audited?
Outside of working with a third party to have a medical insurance audit conducted proactively, there are many things behind the scenes that can trigger an audit. Not submitting adequate documentation with claims can cause an insurance company to flag your practice. Unbundling, or using more than one CPT code for various parts of a procedure or service, can be a sign that a practice is billing improperly or attempting to raise their profits. Upcoding is another red flag that occurs when more expensive services and procedures are being used than necessary, like billing for a 45-minute physical exam instead of a 5-minute brief visit. Mock audits can catch many of these issues before your insurance company does.
Does Your Company Need a Medical Insurance Audit?
If your medical practice does not regularly conduct internal audits, it’s a great idea to work with a third party to ensure that there are not issues present. A medical insurance audit identifies issues with your processes, potential errors that could lead to claim denials and coding problems that insurance companies would use as proof of fraud. Audits also ensure that you are getting paid the proper amount for the services that you are providing. When your practice implements proper medical billing practices that are compliant with both the law and insurance company requirements, it’s easy to pass a medical insurance audit and feel confident.
Protect Your Medical Practice with MKS&H
MKS&H provides tax and accounting services to businesses of every size and in every industry. Our team can help your business gain confidence in your important accounting reports and make better, more educated financial decisions. Contact us today for a consultation.