S&R- MD provides all Clinical and Medical Auditing service for your medical practice to identify, monitor and correct inappropriate billing practices, particularly:
- Random and Targeted Diagnosis- Related Group (DRG) Audits
- Clinical documentation improvement audits
- Admitted patient data item audits
- Invoice/billing audits
Our comprehensive Medical Billing Audit includes
Claims Accuracy
We ensure claims are accurately coded, properly documented, and submitted within the designated time frame. This accuracy helps prevent claim denials, delays, or potential fraudulent activities, that optimum reimbursement for solutions provided.
Compliance with Regulations
We verify compliance with regulatory requirements like Health Insurance Portability and Accountability Act (HIPAA), Affordable Care Act (ACA), and other relevant laws, that protect patient privacy, adherence to billing guidelines, and avoid legal penalties.
Coding Practices
We review the accuracy and appropriateness of medical codes used for procedures and diagnoses. Proper coding is essential for accurate billing, appropriate reimbursement, and compliance with coding guidelines, like the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and more.
Documentation Quality
Our team of experts assesses the completeness and clarity of medical documentation to support billed services. Adequate documentation ensures that medical necessity, treatments provided, and patient information are accurately recorded which support claims.
Reimbursement Accuracy
We ensure verification of the billed charges are aligned with the contracted rates of insurance providers or payers, enabling appropriate reimbursement and minimizing under- or overpayment cases.
Denial Management
We review the effectiveness of denial management processes, analyze the reasons for claim denials, track patterns, and implement corrective actions to minimize future denials, preventing revenue loss and improving the billing cycle.
Billing and Collections Process
We evaluate the efficiency and effectiveness of the billing and collections processes, assess whether claims are submitted timely, clear, and accurate patient statements and collections are properly documented. It helps optimize revenue cycle management and enhance cash flow.
Get In Touch
Whether you’re a healthcare provider looking to optimize revenue or an insurance company seeking assurance that claims are accurate, we are here to help. Contact S&R-MD today to learn more about how our Clinical Coding Services can improve the accuracy of your data and enhance your financial performance.