Key Points to Consider Before Planning Medical Billing Audit

Key Points to Consider Before Planning Medical Billing Audit

9/6/2018 10:21:07 AM   |   Comments: 0   |   Views: 60

Medical billing services in the USA are now focusing on appropriate ways of medical billing audit. Maintaining health care records and creating medical claims is not enough to sustain in the medical billing industry. It is crucial that medical billers and coders accurately code and bill according to the international standards.  According to Group one health source, around 40% of healthcare providers fail to collect $31, 317 for patients. It means that providers lack the abilities to create accurate medical claims or their billing process has some dangerous areas; which are unable to generate valuable profit for healthcare businesses.

 Medical billing auditing either internal or external needs thorough analyzing and evaluation. The purpose of medical billing auditing is to improve healthcare quality and revenue cycle management. It ensures that all of the system errors are removed before time so that billing process runs smoothly. 

Given below are some of the critical points that modern medical billing auditing services and healthcare providers consider before planning an auditing scheme.

Assign a Separate Dedicated Team for Medical Billing Auditing

Medical billing auditing is such a complex process that a dedicated and resourceful team is needed for it. A team so competent is required for this process that:

•    Understands the medical billing process

•    Knows about the healthcare organization’s framework

Identifies the medical industry norms

•    Has the ability to fetch useful information 

The whole team is required to work collectively with the aim of collecting useful financial and clinical reports.  They need to access all of the data and present their findings that what areas are flawed and need improvements. However, the auditing team doesn’t need to be large to avoid any inconvenience.

Device Ways to Remove Errors

Medical billing auditing is not just about finding errors and mistakes in the billing and coding system. But, it also serves to highlight areas of improvements to avoid any problem in future. Moreover, successful companies adapt to changing times. Medical billing auditors also ensure that they help in increasing sales revenue for the billing business as well. 

Only suggestions shouldn’t be made by the auditors to remove errors. But they should also have a way to follow-up on their recommendations to the relevant party to check either any improvement is made or not. 

Create Standards for Medical Billing Process

Medical billing auditors are not required for highlighting mistakes, but also to point out how the current operating system can be improved to increase productivity. Proper benchmarks should be set to keep the flow of profitable account receivables. It is also important to maintain transparency and accuracy in the billing and coding process.  

Medical billing operates via a human resource, so some level of uncertainty in the system is possible.  But, every error can be improved in the medical billing and coding system for healthcare businesses. However, standards should not be fictional and must be realistic according to the capacity of the billing company.

Hire Professional Medical Billing Audit –Outsourcing Company

Instead of performing auditing operations itself by the healthcare business, a practical approach is that companies hire a professional outsourcing company. An outsourcing company can better point out errors without any pressure of any authority.

It can also highlight the necessary compliance related regulations that your company may not be following. They can help you reduce extra cost and increase business profit.


Medical billing companies or healthcare providers can efficiently remove errors in the medical billing and coding system. Hence, the points mentioned above should be kept in mind by the auditors and even medical billing agencies to increase their sales revenue. 

P3Care is a renowned medical billing agency that along with professional billing services, audits healthcare medical billing system.

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