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Medical Claims: How to Audit Medical Claims

It’s important to stay on top of medical claims and ensure that they are being filed correctly. It will save you and your patients time and money that would otherwise be spent missing or chasing errors with the insurance company. The best way to keep ahead of these mistakes is to conduct medical claim audits from time to time.

What does it take to conduct an audit of your business’s medical claims?

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You’ll need to organize either an internal or external review of how your medical claims are being filed, and determine where there are insufficiencies. You will need to determine whether a full audit of all recent medical claims is plausible or if you will instead take a random sampling. Some of the items that you will be examining include the following:

  • Reviewing coding accuracy, and making sure staff are assigning the correct codes for services rendered.
  • Identifying outdated codes.
  • Correctly identifying opportunities for reimbursement.
  • Identifying mistakes that may put the practice at risk for liability.
  • Reviewing changes to policies or procedures.

Once you have identified any possible discrepancies in these categories, it’s important to create a report that can be addressed by an administrator. A plan should be put in place to adjust training or implement new checks to ensure that these discrepancies are taken care of so that medical billing can run more efficiently.

Internal medical audits can be costly, as they take a lot of personnel and hours to complete. Many practices do not have these resources available, so an external review would be better suited to their needs. Hiring a reliable clearinghouse such as Apex EDI can take much of the stress out of audits, and our professional staff and excellent software will ensure that you get accurate reports every time. Try a demo for free and start streamlining your medical claims filing today.

Posted in: Medical Claims

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