Medical billing audits in ophthalmology are an important tool in analyzing and improving your practice’s coding and billing practices. These systematic reviews and evaluations are conducted to ensure accuracy, regulatory compliance, and optimal reimbursement for services provided.
The primary objectives of a medical billing audit include identifying and rectifying any discrepancies, errors, or potential areas of improvement in the billing and coding processes and ultimately helping your practice perform better.
What happens during a Medical Billing Audit?
Medical billing audits can be conducted either by internal or external auditors or by third-party coding and billing specialists.
During the audit, each and every revenue cycle activity will be examined, analyzed, and audited to identify any inefficiencies or malpractices.
Your practice may be asked to provide clinical records like patient medical records, patient encounter forms, copies of submitted claims, explanation of benefits from insurance companies, coding manuals, training records of staff, audit logs, and financial records like accounts receivable.
Audits can be conducted prospectively (meaning before claims are sent out to the payers) or retrospectively (after claims have been sent).
Benefits of Medical Billing Audits
When your ophthalmology practice goes through a medical billing audit, there are a number of advantages and improvements that can be reaped, including:
- Improved Compliance with Coding Guidelines
- Better Documentation Accuracy
- A clearer understanding of billing accuracy
- Clearer and stronger modifier usage
- Higher reimbursement rate
- Improved regulatory compliance
- New knowledge of coding and billing regulations
- Learning opportunities for your staff through education and training
- Better fraud protection
- Recommendations on billing technology software to streamline your process
- Improved risk management practices
If you’re preparing for a Medical Billing Audit, you may want to consider utilizing the services of a billing specialist like Eye Care Billing Consultants because medical billing is our number one focus. We help ophthalmologists improve their billing compliance through our streamlined billing software, which helps decrease errors and claims rejections and increase cash flow.
Reach out to Eye Care Billing Consultants to find out how we can help you through your Medical Billing Audit and work with your practice to maintain financial health, meet compliance regulations, and improve your overall efficiency.
