Billing accuracy and compliance are crucial for medical practices. Mistakes or unethical billing can lead to denied claims, audits, fines, and damage to your practice’s reputation. Implementing strategies to ensure proper coding, documentation, and submission of claims is essential for the financial health and longevity of your practice. This article provides strategies for optimizing billing processes.
Conduct Internal Audits
Regularly auditing your own billing and documentation is critical for identifying any issues before payers do. Select a random sample of charts from different providers and code the visits yourself. Compare your codes to what was submitted to catch any up coding or errors. If you find discrepancies, re-educate staff on proper coding. Also, verify that chart notes substantiate the level of service billed. Keep auditing until you see improvement.
Provide Ongoing Coder Training
Arming your coders with the knowledge and resources to select accurate codes is key. Have coders attend seminars and conferences to stay up-to-date on coding guidelines. Conduct regular training sessions internally led by experienced coders. Have staff take certification courses annually. Provide coders with coding references and software programs for easy access to information when coding patient visits.
Implement Billing Reviews
To catch errors before submitting claims, implement reviews of coded claims. A senior coder or compliance staff member can randomly review a percentage of coded claims to check for accuracy and ensure documentation supports the codes. Educate coders when issues are identified. Reviews will improve the skills of your coding team and reduce denials. Consider having coders review each other’s work as well to reinforce coding skills and knowledge.
Utilize Billing Software
Leverage technology to reduce human error and enhance compliance in billing. Software can check for errors such as duplicate claims, invalid codes, and required data missing from claims. Programs can also verify patient eligibility, coverage details, and authorization requirements before submission. Features like claim scrubbing will improve accuracy. Just be sure staff are well-trained on the software’s capabilities.
Report and Return Overpayments
If your practice receives overpayments from payers, you are obligated to report and return the funds within 60 days of identifying the overpayment. Have standard procedures for determining when overpayments have been received and how to process refunds to payers in a timely manner. Reporting and returning overpayments shows your commitment to compliance.
Perform Internal Compliance Audits
In addition to auditing documentation and coding, perform bigger picture audits on your compliance plan, policies and procedures. Review a sample of medical records and claims to verify adherence to your compliance plan elements such as proper authorizations, coding reviews, and billing software usage. Update policies that aren’t working. Compliance audits ensure your practice billing upholds laws and regulations.
The right blend of auditing, training, technology and billing oversight will help minimize claim errors and reduce instances of upcoding or other improper billing in your practice. Focusing on accuracy and compliance protects your revenue and reputation.
