Medical Billing & Coding Audit – How to Pick the Right Company for Your Audit

  • Monday, July 11, 2022 9:32am
  • Blog

Fortis Medical Billing is our recommended provider for medical billing audits.

Nowadays, performing coding audits has become a necessity for medical establishments. These organizations are often working with insurance companies and payments from clients, which is why it is essential to use the right code in order to manage the revenue. Not performing regular audits can lead to significant losses in revenue.

There are plenty of companies out there that can take care of your medical billing audit, along with your other medical billing tasks. You just need to find the one that suits your medical institution the most. Here are some aspects that can help you pick the right company.

  1. Experience

How long has the company performed medical billing and coding audits? Is this their main area of expertise, or is it just a side service that they offer? How many experts have they hired to undertake this task in particular? If someone will be performing audits for your hospital, they need to have the necessary experience for it.

The best way to find this out is to do some thorough research. A reliable company would usually post this information on their website. They can also offer you that information upon contacting them so that you won’t have to do too much digging yourself.

Other than that, you can find reviews online, where former clients may have potential information. Someone may have asked something that you didn’t, which can help fill in the blanks for you. If they performed audits for those medical centers, then you should be able to find information on whether the job they did was good or not.

Another very important aspect to keep in mind is what their experience is with different-sized facilities. Do they mostly work with smaller hospitals, or do they work with large hospital audits as well? Do they have experience working on-site, or do they just handle things remotely?

You should also find out about their experience with partnering with their clients. Audits are different than regular revenue cycle management, and they need to be honest and open to partnerships. A medical billing and coding company with enough experience will know about this.

  1. Planning and Communication

The last thing you want is to feel like your billing company of choice is not giving you all the data regarding your audit. You need to go for someone that communicates openly about their plans, before doing anything.

Many low-rated companies out there are hired to do audits – and while they do not do a bad job at it, they do not inform you of anything beforehand. They simply use the statistics that they get from you and do not give you any more information – present or past. For someone with a coding problem in their hospital billing process, this is not very reassuring.

Go for someone that will communicate everything to you beforehand. Good communication needs to be practiced even before you sign the contract. For example, if the billing company professional does not even bother to give you stats or information about their cases, or does not set check-in periods, then you are dealing with a team that likes to work alone.

Teamwork is very important, especially when it comes to hospital billing and coding. So, look at how the company is willing to communicate with you. Do they set regular check-ins? Perhaps they offer to hold a coaching session in their plan. Is their customer support any good, or do you have to call endlessly in order to get in contact with anyone?

If you feel like you are endlessly kept on the line – or not even answered – you might want to reconsider. There are multiple companies out there that put the peace of mind of the client first.

  1. Reputation

A medical billing and audit company needs a good reputation. This is usually the type of information that you can find by going through reviews on independent websites. No company in their right mind will put bad reviews on their front page, which is why you will need to dig deeper.

Look at their retention rate and their claims rate. For a company to be considered reputable, both of these parameters must be at least 95% or higher. It means that they were successful in most of their cases and that they managed to make a good name for themselves.

That being said, you also need to take a good look at the number of clients that they had in the past. If they have a good rating and a total of 10 past clients, it might not mean that they have a good reputation – we are just talking about a couple of clients with some easy audits. Look into how many average clients they had, and cross-reference it with how many years they have been active.

  1. Performance and Follow-Through

Make sure that the medical billing company of your choice will offer a detailed report of their statistic findings, as well as trend reports. After all, the purpose of an audit is not only to find a problem but also to fix it in the long term. The audit will have to educate you on what went wrong. It must also suggest improvement paths for that specific area.

Once more, a good way to find out whether they fit the criteria is to look into other reviews and references. Are there any reputable hospitals that would recommend them to you? What is their success rate in helping companies in the long run?

You should also look into what kind of software they use in order to conduct a medical coding audit. Each company will utilize some sort of automation service, but they may differ from one company to another. If you have a specific type of software that you intend to use during the audits, then you may want to inform them of this in advance.

  1. Follow-Up

Many medical billing companies will simply finish their job and take their leave, moving on to other hospitals in need of an audit. However, a good medical billing and coding company will schedule a follow-up once the task has been completed. This is exactly the kind of company you should be looking for.

If a billing and coding company schedules a follow-up, it means that its purpose is to ensure the client is as satisfied as possible with the services. This is particularly important if the company also provides training for conducting audits.

A reliable company should also schedule the next audits. They understand that medical billing auditing should be a regular thing and that it should be done at least once a year. A company that offers good quality services, in the long run, is one that wants to help you and has your best interests in mind.

  1. Cost and Payment Method

Medical billing audits must be done on a regular basis. This means that you need to make sure you can cover the costs. With that in mind, you should not go with the least expensive company that you can find. Usually, if the prices are low, it means that certain services are not provided. If you have specific requirements for your medical billing audit, you should make sure that the feature is covered within the cost.

Make inquiries on how they plan on charging you. For example, some companies will ask for a flat fee for the services. Other companies will charge based on the complexity of the audit, as well as the results. You should know this information beforehand.

Ask about flexible payment methods as well. For instance, you may want to pay in installments, or you may have a preferred digital wallet that you want to use. You have to discuss the matter of payment first before you sign anything. This way, you can avoid potential misunderstandings.

  1. Security and Compliance

When conducting a medical billing audit, the company will have access to essential data of your company. Before hiring anyone, you need to know exactly how that data is handled and protected. For instance, once the billing company finishes with your audit, will they give back that information to you? Or will they retain those files and all the data?

You should make sure that the company is HIPAA compliant. This should give you peace of mind that your data is handled based on the HIPAA guidelines , and they do not mishandle the confidential details of your patients. Ask about the security methods that they use in order to prevent potential breaches so that you know you are safe at all times.

The Bottom Line

A well-conducted medical billing audit can make the difference between well-flowing revenue and a situation where revenue is lacking. To prevent any issues, you may want to conduct a medical billing audit every year. Make sure to hire a reputable medical billing and coding company, as this is quite a delicate and important matter.

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