Data Analytics
12 Apr

Billing Integrity Audits – How They Help Your Practice Grow

Billing Integrity AuditOne of the many services Legacy Consulting provides are Billing Integrity Audits. There are several layers to this kind of audit and we can provide all or just some of the pieces, depending on our client’s needs. These audits can prove useful to assure compliance and ensure your practice is being reimbursed properly for its services.

Proper Documentation

We will select a list of patients from the top 3-5 payors and do a thorough audit per provider to ensure proper documentation is being done to meet payor specifics and billing rules, as well as determine if any of the clinical staff need coaching on their documentation methods based on payor specifics.

Coding and Billing

Along with the documentation, we will review billing and coding to ensure your practice received the maximum reimbursement allowed, based on the clinical documentation. We will identify any gaps with modifiers, CPT codes or diagnosis codes, particularly with ICD-10, and ensure the appropriate billing levels were sent out on each claim.

Audit

Payment Review

Ensuring your practice is being reimbursed correctly is key to your revenue cycle. We can do an assessment of overpayents, underpayments, fee schedule and charge master reviews to ensure you are charging enough to be reimbursed by your top payors correctly.

Assessment

Once we have completed our review of the documentation, coding, and billing, we will provide a full assessment to the practice of any challenges or deficiencies we identify during our audits. We will provide a suggested action plan and are available to help carry out any of the steps along the way. We can even help correct and re-bill any claims that can be resubmitted.

Legacy Consulting Services can assist your practice by ensuring the claims that go out your door are correct and no money is being left on the table. Contact us today to have us help your practice realize its collection potential.

The 5 keys to RCM

Donna White

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