Medical auditing involves conducting an internal or external review of coding accuracy, policies, and procedures to ensure you are running an efficient and hopefully liability-free operation.
Reasons for an Audit
To determine outliers before large payers find them in their claims software and request an internal audit be done. To protect against fraudulent claims and billing activity. To reveal whether there is variation from national averages due to inappropriate coding, insufficient documentation, or lost revenue. To help identify and correct problem areas before insurance or government payers challenge inappropriate coding. To help prevent governmental investigational auditors like recovery audit contractors (RACs) or zone program integrity contractors (ZPICs) from knocking at your door. To remedy undercoding, bad unbundling habits, and code overuse and to bill appropriately for documented procedures. To identify reimbursement deficiencies and opportunities for appropriate reimbursement. To stop the use of outdated or incorrect codes for procedures. To verify ICD-10 electronic health record (EHR) meaningful use readiness.