Medical Bill Auditing Services – Compliance and Audits

Why do we need compliance rules and audits? Most people would say to stay out of jail for breaking important rules, regulations, and laws as it pertains to  medical billing practices. However, let’s dig a little deeper on why compliance and audits are important to the medical practice.

Every year the OIG (Office of Inspector General) puts out a work plan that outlines what THEY will be focusing on in that year looking for fraud and abuse.  Each medical practice should obtain a copy of this report and seek to align their practices so that they are following all laws, rules, regulations, and procedures.

Medical Bill Auditing Services – Compliance and Audits

In the career of medical billing, rules, laws, and regulations are changed frequently. It is important to have at least one compliance officer in every office that stays up to date on important changes. This not only assists with reimbursement by following the rules and reducing the amount of denied claims, but it also assures that office procedures in place are protecting patient confidentiality by following HIPAA and HITECH Act laws and regulations.

Written standards and internal audits assist the practice in being organized and understanding if there are areas that need improvement. Also, critical errors can be caught and fixed.  A good compliance plan reduces medical billing mistakes, assures more accurate claims payments, and improves documentation, and making sure that the practice is following good, ethical, and moral practice standards.

In a good medical billing program, compliance and practice standards are thoroughly taught. Random in-house audits assure that the practice is following the plan and not making critical errors that break regulations, laws, and acceptable practice standards.

By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years.  Interested in quality medical billing training? Find More Information about Online Medical Billing Course

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