Many medical practitioners are yet to understand and key into record auditing, especially now that the Department of Health and Human Services’ Office for Civil Rights (OCR) conducts periodic audits to ensure that covered entities and their business associates comply with the requirements of HIPAA’s regulations, government programs and commercial payers conduct pre- and post-payment reviews to identify improper payments.
Medical auditing should be an intrinsic part of any quality administration. This should not be limited to the management alone but extended to members of staff within the organization.
Do you still doubt the importance of regular record audits? Maybe No! But, have you considered the reasons you should be conducting periodic record audits? That is what this piece is aimed at; to enlighten you on the importance of medical auditing. But first, let’s find out what medical auditing is.
What is Medical Auditing?
Medical auditing is the process of conducting both external and internal reviews of your medical practice, including the codes of medical procedures and policies, with the aim of running an efficient and liability-free system. Just like all related forms of audit, medical auditing involves the examination and review of medical records and practices to ensure that your facility and doctors are in compliance with the existing regulations and the required standard of medical practice. But why do you need to audit your practice regularly?
The reasons for regular medical auditing
Here are some of the reasons to start auditing your practice on a regular basis:
1. Record Auditing Improves your Healthcare Practice
If you have been thinking of how to bring about the much-needed improvement in your practice, periodically auditing your record can help you a lot. Medical auditing helps you to update your clinical records and also identify the areas of your practice that need improvement.
Apart from identifying potentially problematic areas that need your attention, auditing gives you the opportunity to confirm existing processes that are yielding the expected outcomes so that you can learn from them. As you already know, poor care is expensive, and auditing improves the cost-effectiveness of your practice. It helps at identifying areas that generate (cost) savings with little or no impacts on patients’ care. This can be in form of guidelines for early diagnosis of a sickness, reduction in the length of admission or stay to reduce complications, standardized rules on drugs, and so on.
2. Record Auditing Detects Poor Coding Practices
Since you are not knowledgeable in coding, there might be the possibility of incorrect coding and reporting in your practice, which can lead to delayed reimbursement or lack of it entirely. With professional medical auditing carried out by trained experts, you can be sure of identifying such mistakes and making amends early enough to avoid the consequences. Periodic auditing helps to detect all hidden errors like under coding, over coding, and poor unbundling practices. Undetected poor coding practices can be detrimental as ignorance may not be accepted as an excuse before the law. Such errors are often noted by federal agencies when they come knocking or when any matter that might lead to questioning the steps you have taken to prevent and spot abuse or fraud arises. Record auditing will not only save you from keeping incorrect codes ignorantly, it will also save your business from embarrassment before the law.
3. Record Auditing makes your practices compliant with the law
Once any law has been enacted, it becomes a little god. Failure to comply with such existing law is regarded as rebellion, and there’s provision for offenders to be punished accordingly. Medical practice is not an exception: there are rules, regulations, and policies governing the practice, which you must comply with. Medical auditing is, therefore, necessary to reviews your clinical documentation, records, and reports to ensure that your practice complies with existing rules governing the practice so that when the relevant authorities come for their routine inspections, you will have nothing to worry about.
4. Record Auditing Prevents Missing Revenue
And it is not just about compliance with the law, your revenue is at stake too. As a medical provider, you have to be reimbursed for every service you offered, but there are times you experience delay or don’t get reimbursed at all due to improper coding or poor documentation. One good way to avoid these situations is periodic record auditing. If you have been experiencing a delay or lack of reimbursement in the past, it is time to embrace regular medical auditing to improve your revenue collection mechanism. Record auditing ensures timely reimbursement, but you need to start now!
5. Record Auditing Protects Against erroneous Claims
Have you been wrongly billed? Too bad if you have, and great if you have not. But the truth is, you can be a victim of erroneous claims. Interestingly, periodic medical auditing will keep you away from all categories of wrong claims.
6. Record Auditing Brings Improvement in Patient Care
Medical auditing can go a long way in improving the procedures in place for taking better care of your patients by ensuring proper documentation, reducing investigations, and identifying patients with chronic health challenges that require proper follow-up. Also, auditing ensures regular checks on departmental work and early adoption of new policies that improve the welfare of patients. Furthermore, it encourages inter-departmental communication and professional development.
With over 19 years of experience in medical auditing, WCH is your best ally in making sure that you get the best from your practice while being compliant with all the rules and regulations of the practice. At WCH, we understand billing and credentialing processes from A to Z. We’ve got experiences working with government programs too. Our certified auditors and coders work with doctors across all medical specialties.
