Medical billing compliance

Medical Billing Compliance – Audits Are a Great Preventive Measure

“Proper planning/preparations prevent poor performance”. We have all heard this phrase, or some variation of it, before. When thinking about medical billing compliance, the statement rings true. Concordis Practice Management has posted medical billing compliance blogs in the past on our website, such as:

  • “Complying with your Medical Billing Compliance Plan” (May 10, 2017)
  • “Are Coding and Billing Mistakes Hurting your Medical Practice” (October 31, 2016)
  • “The Importance of a Coding Review” (August 16, 2016)

The articles can be found on our website at . We encourage you to refer to these articles, and share them with your staff.

Planning should include sharing the monthly claims denials report with physicians and key leadership, and training the physician on the proper documentation to support their CPT codes. Your practice management system reporting package should include a claims denials report showing individual physician data. The billing staff should assist the physician(s) in eliminating the errors that caused the denial. The more common denial reasons include incorrect use of modifiers and incorrect NPI numbers. And, as we know, denials delay payment.

A key preventive measure should include the medical practice leadership meeting regularly with the billing staff to discuss claims denials trends. Additionally, the Practice Manager should review the practice management system reports to determine if there are claim errors that could have been prevented before the claim was sent to the clearinghouse. Correcting these errors prior to submission is essential to reduce denials.

Another key preventive measure is conducting an internal or external audit of your medical practice’s billing procedures, and sharing the results with key leadership and the compliance committee. The audit should be conducted annually; however, more frequent audits, especially for a physician just joining the practice, are recommended. The audit should better prepare your medical practice to be compliant with the various payer rules and regulations.

The audit should alert the medical practice to simple mistakes, such as the male patient is referred to as “her” throughout the documentation, or if there were treatments documented that do not support the coding. The audit should also indicate a pattern of repeated billing errors. Furthermore, the audit should alert you to more serious billing errors that could result in an audit from Medicare or a commercial payer.

Even with the best preparation and prevention measures, any medical practice could receive the dreaded RAC (Recovery Audit Contractor) letter that starts with, “This letter is to inform you that you have received a Medicare payment in error, which has resulted in an overpayment…”. Your timely response to a notification letter is essential. In Texas, many professional liability insurance companies can assist you with your response to a RAC letter. Contact your professional liability insurance company to learn more about this service. A healthcare attorney can also assist you with your response.

By complying with your medical billing compliance plan, you will discover billing errors earlier, and be able to correct the errors to ensure they do not recur. As stated previously, planning and prevention are key steps.

Concordis Practice Management is pleased to have Nancy Sands, CMPE, CPC, CPMA, on our Team to assist medical practices with their medical billing audits. In addition to Ms. Sands being a Certified Professional Coder, she is also a Certified Professional Medical Auditor. Contact Concordis today at 210-704-1014 to schedule a consultation to discuss a medical billing audit.



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