Payment Integrity Audit – Underpayment Recovery in Pahala

A medical claims audit could be the most beneficial tool in your clinic's compliance arsenal. When done correctly, an audit can improve claim accuracy and make medical billing run more smoothly. It is critical to understand how to audit medical claims, whether you conduct your review internally or hire an external auditor.We are ensuring accuracy and compliance in Under paid claims audit.

The key to ensuring a smooth audit is to first streamline your claims process with a renowned clearinghouse. A look at the claims auditing process and the role that medical claims software can play in a successful audit is provided below.

• The purpose of auditing a physician’s billing is to verify that the services were paid in accordance with the rates and regulations specified in the MCP (Medicare Care Plan) payment.

Before delving into the essential steps of a medical claims audit, it's important to understand the advantages of scheduling a formal review of your claims and appeals. Here are some of the main reasons why you should audit your medical claims on a regular basis:

• Examine compliance with the most recent industry standards and regulations.
• Check that staff is using the correct health service codes.
• Highlight errors that may increase your organization's liability risk.
• Improve the accuracy of documentation and reporting.
• Prepare for industry compliance audits.

The below are the key steps initiated while doing the audit.

• Assembling our claims review team
• Picking up a sample of the medical claims.
• Effectively reviewing each claim for accuracy.
• Discovering the mistakes and the discrepancies.
• Organizing the audit findings into a report.
• Reviewing the audit findings with the staff.
• Working on the plan of action to restrict
• Scheduling for the next audit