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  • Operational efficiency.
  • Compliance.
  • Optimal earned reimbursements.

Every healthcare provider is trying to achieve these factors to ensure revenue integrity. But the tighter profit margins and constantly declining reimbursements have become a major challenge for healthcare practices. Laboratory practitioners are in need to identify and fix the possible reasons for an unpredictable revenue loss. Because, recently, it has been observed that the majority of healthcare providers lose millions of dollars without knowing the key factors behind it.

Losing hard-earned revenue is undoubtedly an overwhelming and frustrating thing for healthcare practitioners. Therefore, they should make sure that their laboratory practice isn’t leaving even a single penny on the table. In addition to this, compliance issues have also become a constant headache for healthcare practices. Failure to comply with the ever-evolving federal/state laws can land healthcare professionals in legal trouble. For instance, if your lab billing system isn’t compliant with the rules and regulations, proposed by the concerned authorities. Then you may end up in heavy fines, federal penalties, cancellation of licences and even imprisonment.

However, it is the most frequently asked question: how can healthcare practitioners come to know the loopholes in their medical billing systems? According to healthcare experts, conducting regular medical billing and coding audits is the best way to get deep insights into revenue cycle management.

Before diving into further discussions, let it be clear that: billing audit is a deep and careful analysis of the medical documentation, all health records and medical billing data to ensure the highest level of accuracy, effectiveness and specificity. Generally, there are two types of audits: external and internal.

An internal billing and coding audit are usually performed by the healthcare staff of an organization. Some large scale practices have internal audit departments that are responsible for examining and reviewing all aspects of healthcare facilities including revenue cycle management.

On the other hand, an external audit is performed by a third party that is not a part of the healthcare organization. Healthcare practices can utilize both external and internal medical billing and coding audits to maintain compliance and stay financially fit.

Despite knowing the fact that regular audits have become a need of the hour. Many lab practices are still lagging behind in this aspect. There might be certain reasons as: bearing the high expense of hiring a full-time internal auditor is quite challenging for small scale practices. Another major problem is finding auditors, who are highly trained and have a proven track record in auditing medical records, particularly for coding and compliance. For such practices, hiring billing and audit companies is the best solution. In this way, they get rid of the excessive financial and administrative burden associated with auditing healthcare data. You just need to pay the fixed amount and in return, you acquire the assistance of the billing and coding experts as well as auditors.

However, in the case of the in-house auditing department, many lab practices don’t have a systematic plan for auditing. They use manual methods i.e. spreadsheets, to keep a track record. Which is not effective and always leaves room for errors. There are still some healthcare practices that don’t conduct audits at all due to both resource and budget constraints. Which impacts the revenue integrity and success of the lab business as a whole.

How Can You Conduct a Successful Billing & Audit?

Riddles of whether you choose to outsource or keep the billing audit in-house. You must always keep in mind the following strategies to conduct a successful audit.

1. Create a Successful Roadmap

The financial and compliance success of a healthcare practice is highly dependent on it. However, conducting successful audits for medical billing and coding isn’t a cup of tea. The successful execution of this complicated task requires skilled manpower.

Without getting the assistance of a dedicated and well-trained team, laboratory practitioners can’t perform the billing and coding audit efficiently. Therefore, the first preference should be hiring medical billing auditors. Then develop and circulate a formal audit plan.

2. Risk Assessment

The next step is to gather the required data including billing reports. Compare the most recent reports with previous ones i.e. month-over-month or year-over-year, to identify irregularities. Then make a comprehensive report detailing how CPT codes are being reimbursed. Deep dive into a pile of unresolved medical claims to identify the key factors that cause claim rejections and denials.

More importantly, you should pay special attention to the coding errors. Because some coding errors such as: upcoding, under-coding, unbundling, incorrect modifiers etc, can not only result in financial loss. But also land healthcare providers in legal troubles. Because such coding errors are considered as healthcare frauds. Having a history of such errors ultimately results in federal penalties. In this way, you become better able to identify the areas of improvement and take preventive measures.

3. Make Required Changes

Once you get complete information on which areas need improvements. Set a target for improvements. Such as; decreasing the claims backlog, preventing future claim denials, and elevating revenue per patient.

Adopt technology-driven laboratory billing solutions to increase the efficiency of the entire RCM process. Furthermore, conduct regular training sessions for your front desk and backend staff. So they can stay aware and informed of their responsibilities and the latest changes in the healthcare industry.

4. Develop a System of Accountability

Having a system of accountability doesn’t mean punishing the employees, who couldn’t perform better. It simply gives administrative staff a sense of responsibility and guidelines: how can they play an active role in ensuring the success of a healthcare business. You should clearly assign the roles: which position is responsible for which categories of work.

Hiring a Third Party

As we have already discussed, managing an in-house billing and audit team isn’t easy for small scale practices. But now the trend of outsourcing billing and coding audit services has become a rising trend even among large scale practices. Due to its immense benefits, healthcare providers prefer to hire a reliable third party to conduct regular audits. Outsourced experts are capable enough to analyse the healthcare records to catch internal theft, fraud and inefficiencies. They provide comprehensive reports powered by big data analytics. Which enables you to make wise business decisions.

If you are looking for a reliable partner to make your lab billing system proficient and regular billing as well as coding audits. Laboratory Billings is a one-stop solution for your healthcare facility. We help lab practitioners across the United States to improve their billing and coding efficiencies, resulting in maximum productivity as well as profitability. Schedule a free demo of our reliable services.