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How a Claims Audit Answers Questions

What is a Claims Audit?

Every medical practice must be compliant with federal and state guidelines as well as adherent to insurance company regulations. The rules are designed to ensure quality healthcare as well as fair and lawful financial practice. An audit is the process of checking compliance, financial integrity, patient safety and secure storage of medical information as well as a comprehensive check of the billing process. Comprehensive and accurate audits empower practices to provide the best standard of care.

 

Why Conduct a Claims Audit?

Insurance providers and federal auditors hold every medical practice to account for legal compliance. Finding yourself in the position of being audited by an external organization can be a stressful, or catastrophic experience, especially if you simply do not have the answers at hand. Non-compliance leads to potential prosecution, the cost is not just financial but could also result in criminal proceedings. There is also the likelihood of insurance providers severing ties with the practice. However, all of this is avoidable.

How Can A Claims Audit Help?

Many in-practice day-to-day tasks are time-consuming, open to error, and if asked for a status update at any given time, it can be difficult to give an accurate answer. How can this be helped by a claims audit? With software that aids smooth running of every task, the answers are at your fingertips.

  • Codes assigned and formats used more easily verified
  • More compliance with insurance company requirements
  • Reduce unnecessary claims denials
  • All logged transactions can be reviewed
  • Claims initiated and managed efficiently
  • Provider details verified

 

A Software Solution For Your Medical Practice

 

There are software packages on the market for practices of any size. While there are many available, it is crucial to choose software that integrates with your EHR, medical billing and RCM. Your software should be capable of a comprehensive and customizable audit that can analyze and detect errors in the billing process, claims and compliance. 

 

Intelligently designed software seamlessly integrates with your data to produce reports on demand, empowering you with the ability to correct errors, streamline the billing and claims process and answer questions. 

How A Claims Audit Can Answer Questions

 

Whatever questions you need answered, it should be possible to choose the parameters of your audit to produce the answers, quickly and accurately. An audit can help speed up the claims process leading to a faster payout. Your software should enable you to feel safe in the knowledge that:

  • Specific questions can be answered
  • Errors are being detected and resolved
  • Staff are educated to have a solid understanding of every process 
  • Billing is accurate and up-to-date
  • You are compliant
  • You are protected against the threat of litigation
  • Healthcare providers can focus on quality care for patients
  • Your practice is sustainable for a healthy future

Click here to find out how you can give your practice a safe and sustainable future.

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Victor Gane, PhD

Chief Executive Officer