Medical bill auditing involves assessing whether the clinic complies with all services provided. It is a bureaucratic step to ensure your processes are efficient and accurate.
Typically, the documents that undergo medical bill audits are:
- Contracts;
- Medical consultation guides;
- Database;
- Medical records, if necessary.
Performing an audit is a great way to identify which processes need improvement. It also helps reduce costs and enhance information security.
Here are some steps to audit medical bills:
- Information collection: Separate all relevant information, including medical records, invoices, procedure codes, health plan contracts, and coverage policies;
- Review of medical records: analyze medical records to verify that patient information, medical history, diagnoses, treatments performed, and medications prescribed are documented wholly and appropriately;
- Coding verification: review procedure codes used on medical invoices to ensure they correspond to the services provided and are correctly coded according to established standards;
- Analysis of supporting documentation: check whether all necessary supporting documents are attached to invoices, such as laboratory reports, examination reports, justifications for authorizations, and medical prescriptions;
- Assessing the adequacy of charges: verifying that medical records justify the services charged and are in compliance with health plan contracts, coverage policies, and billing guidelines;
- Identifying errors and inconsistencies: look for coding errors, duplicate charges, undocumented services, undue charges, and any other discrepancies that may affect the accuracy of the accounts;
- Results report: document all audit findings, highlighting the problems identified, suggestions for remedial actions and recommendations for improvements to billing procedures.
It should be noted that the audit of clinical medical bills may be complex and requires specialised knowledge of coding, health codes and billing systems. In some cases, it may also be appropriate to rely on professionals specialised in the audit of medical bills or to hire external audit firms to carry out the task impartially and with experience.
How do you make a medical referral to professionals at your clinic or office?
Financial transfers to professionals in a clinic or practice must be made transparently and accurately. To do this, they must be informed about the amounts to be paid, the frequency of payments, and any other relevant information.
A model for calculating the transfer must be established. This model may vary according to the type of service provided and the medical specialty, among other factors.
The payment frequency must be defined in advance and strictly adhered to. This payment is usually made monthly but can be adapted according to the agreement between the parties.
Generally, the doctor receives at least 70% of the amount, and the remainder (30%) goes to the clinic. It all depends on each professional’s contract with the company.
When the clinic lacks data integration, such as medical software, essential information for transfer is scattered, such as the procedures performed, who performed them, and the quantities.
An automatic medical referral tool is the best way to avoid common mistakes and optimize time.
In medical software, you can obtain some differences, including:
- Recording payments directly through the diary or medical record;
- Configuration of different values according to the procedure and health plan;
- Automatic medical transfer;
- Payment for consultations in installments;
- Registration of values in bank accounts;
- Generation of Wise Medical Billing consultation guides in batches;
How do you optimize medical billing with medical software?
Quality medical software with Wise Medical Billing will bring more organization and profit regarding medical billing.
After all, you will make the process automatic, free from typical errors, and facilitate any eventual audit. Not to mention that the security of electronic data is immensely more significant than that of paper files.
Furthermore, all your financial management and administration will be favored since a system can have tools such as:
- Electronic medical record ;
- Digital prescription ;
- Medical diary ;
- Online scheduling ;
- Medical transfer;
- Inventory control;
- Teleconsultation ;
- Medical marketing ;
- Internal chat;
- And much more!
By centralizing your clinic’s information in a single location, you achieve the management you’ve always wanted for your business and have more time to focus on other activities.
If you already know that you want to have these advantages in your day-to-day life, download our free medical software comparison spreadsheet and make your choice:
More tips to increase your clinic’s revenue
In addition to optimizing medical billing agency services, other strategies can be used to increase the clinic’s revenue:
Improve appointment scheduling: a good scheduling system can increase the retention of patients, who are more likely to return and recommend the clinic to others;
Expanding the services offered: adding new services or specialities can increase the clinic’s revenues and visibility, if well planned.;
Trends and innovation: Keep up to date with trends and innovations in the health care sector. Adopt technologies that can improve service quality, offer patients greater comfort or reduce operating costs.
Implementing these strategies will create an environment conducive to increasing your clinic’s revenue.
Conclusion
As we have seen, RCM billing is a key business element in the efficient functioning and financial sustainability of any health clinic. Properly implemented and managed, this process can ensure sound cash flow and enable the expansion of the services offered. It is therefore essential to keep up-to-date and to apply best practice in this process. Adopting good practice can help you to avoid errors, optimize time and resources, and maximize the revenue of your clinic.
In addition, keeping up to date with industry regulations and trends is crucial to stay in compliance and adapt to changes. Are you ready to take your billing process beyond? We offer a free trial to allow you to try all features and see how Wise Medical Billing can be of benefit to your practice. Don’t waste your time! Register now and see how our platform can simplify the management of medical bills and give you more time to concentrate on what matters: the care of your patients.
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