While the coronavirus pandemic brought many things to a standstill, it caused a massive overload for doctors and hospitals. As insurers and company-funded plans are dealing with claims and bills, having a medical claim auditing service review the payments is essential. When utilization rates skyrocket, they put the entire system under increased pressure, and the chance for mistakes increases. While most claim processing is handled electronically, human oversight is still involved, and labor shortages have intensified the situation for some. Correct claim payments benefit everyone, and audits can help.
Most of the news in claim auditing is on the payer side, but providers can also benefit. Ensuring bills are correctly coded is a chief consideration and helps capture lost or missed revenue. When your staff is stretched thin, the opportunities for errors and omissions increase, which is why many practices and institutions review their billing. One of the most significant opportunities is errors that repeat. Staff can be informed and trained to avoid them when they are flagged in an audit. Some are simple oversights, and others may be misunderstandings. They all show up when all claims are reviewed.
There are several cases for bringing in an outside audit firm. The first one has to do with software. Most claims auditors have highly advanced technology that allows them to review claims quickly and accurately. In-house teams often attempt to audit using billing software, and it's not as effective at finding errors. Another reason is that an independent firm has no agenda other than accuracy and provides an objective view of billing. Their independence assures you of an accurate report, and often their experience helps them make suggestions for long-term systemic improvements.
As you're reviewing your options, consider specialist audit firms. They have unique expertise, robust systems, and complete independence. Larger audit firms may be geared more toward tax or HR needs, and their software may not be as specialized. When you work with a firm in the trenches every day reviewing claims, they know what to look for and bring experience. It saves you time and money and increases the chances your audit will be beneficial. Audits today commonly lead to recoveries of four times their price. It's an eye-opener for anyone claiming that auditing is more of a compliance issue. It has become a powerful management tool for payers and providers alike.
