How to perform a physician practice internal billing audit

„„ How to perform a physician practice internal billing audit An internal billing audit can help ensure appropriate payment and compliance with applicable laws. Auditing physician charges and billing practices is burdensome, but it will typically yield improved claims management processes, cash flow and compliance with applicable laws and regulations. An annual audit allows physicians and practice staff to identify specific coding issues that may recur in similar claims submissions. Careful pre-submission monitoring and review of these similar claims may safeguard against errors that could result in a claim denial. An internal audit allows the physician and practice staff to identify incorrect billing patterns before claims are denied or outside auditors assess penalties. What is a billing audit? A prospective or retrospective physician practice billing audit is commonly performed to ensure the ®physician is submitting appropriately coded claims according to Current Procedural Terminology (CPT ) *codes , guidelines and conventions, and payer payment policies, as the physician is ultimately responsible for claims submission, even if a billing service or clearinghouse is used for claims submission to payers. In a prospective billing audit, a designated practice staff person or internal compliance officer reviews the claims before they are submitted to the payer to ensure the appropriateness of the coding, documentation and adherence to health ...