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 ...