Insurance Audits – Are You Prepared?

by | Published on Aug 8, 2012 | Medical Record Review

Validating physician coding and documentation are important to ensure that your medical practice is not exposed to financial risk. Insurers can call for the medical records of your patients at any time; therefore you need to be ready with accurate patient data. Medical chart audit services can be obtained from a medical review company that is experienced in providing chart audits and other medical record review support services. Timely medical chart audits will help you evaluate your medical claims and clearly understand what to expect from a payer.

Medical chart review is an important service that is part of medical chart audits, and this involves the detailed review of your documentation and coding by a professional medical auditor. The assessment will focus on ensuring the precision and completeness of your documentation, as well as the accuracy of the diagnostic and procedural codes assigned. So any compliance issues in these areas can be easily identified and rectified. Usually the findings are clearly represented in spreadsheet format and as written reports. It will help you evaluate whether the claims you submit are supported by sufficient and accurate documentation.

The professionals at your medical review company will also examine the payments as well as denials received in your patients’ accounts receivable. The audits can bring to light refund situations as well. This will enable you to send the refund for any medical billing error without waiting for the insurance company to send you intimation regarding this. Medical chart audits will also reveal whether your medical office is fully prepared for the new ICD-10 code sets. Sufficient preparation is necessary to improve clinical documentation, accurate coding and proper payment.

Chart audits provide excellent learning opportunities as regards the documentation and coding practices in your medical office and enable you to adopt necessary remedial action to enhance performance.

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