In order to get paid for the work they do, doctors and their staffs must stay informed regarding all the new regulations presented by the government and third-party payers. Audits improve the chances that your group is compliant with Federal and state regulations, and internal audits can infuse newfound cash into the practice by discovering revenue loss.
The old caveat “If it isn’t documented, it wasn’t done” applies even more in this era of electronic health records (EHRs) and data analytics. Insurance companies deny claims for myriad reasons, and the Medicare Fraud Strike Force Teams use data analytics to prevent and combat healthcare fraud, waste, and abuse. If you bill a lot of one CPT code, it is almost guaranteed that it will eventually trigger an audit. There may be nothing wrong with your coding and documentation, but you will be subject to more scrutiny because payers run claims through analytics systems to identify patterns that fall outside the bell curve. There are many audits available that you can perform, including the Occupational Safety and Health Administration, Corporate Compliance business associate agreements, HIPAA, and revenue cycle management.
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