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- +1 202 555 0133
Our meticulous medical billing audit services uncover revenue opportunities and streamline claim processes, driving faster reimbursements and maximizing profitability with precision and expertise.
We perform medical billing audits for all types of claims, including Medicare, Medicaid, commercial insurance, and self-pay accounts
We conduct comprehensive medical coding audits for a variety of medical records, including inpatient, outpatient, professional fee, and home health documentation
We enhance your cash flow by auditing aged claims for inaccuracies and reprocessing denied claims through our comprehensive collection aging audit
We assist providers in preparing for and responding to government and payer-mandated audits, including TPE, RAC, OIG, DMEPOS, and Medical Necessity reviews.
We perform both internal and external clinical audits to evaluate the quality, safety, and effectiveness of patient care and clinical outcomes.
We conduct thorough audits of Medicare patient charts to ensure that every dollar billed is properly justified and compliant, guaranteeing that your practice receives full and fair reimbursement.
When you partner with a trusted medical billing provider like CarePlus, we streamline the billing process by acting as a liaison between your specialties and insurance companies. Before submitting claims, we utilize advanced software that applies automated rule engines to identify potential errors that could result in denials. CarePlus goes beyond standard claim scrubbing by leveraging our clearinghouse partner’s premium scrubbing tools, which detect errors more efficiently and accurately than manual methods.
Additionally, our automated claims scrubbing services eliminate the technical complexities of the claims process, allowing medical professionals to focus on what matters most—providing quality patient care while ensuring compliance with regulatory standards
Regular medical billing audits and effective revenue cycle management offer significant benefits to healthcare providers, including improved compliance, optimized revenue through claim payment maximization, and stronger relationships with medical payers:
Medical billing audits enhance the accuracy of a provider’s coding practices. These audits can identify coding errors before government or private insurers detect them, boosting the confidence of coding teams and ensuring the use of the most current codes for patient billing.
By submitting claims that accurately reflect the services provided, healthcare providers foster positive and transparent relationships with payers.
Routine billing audits help ensure providers remain compliant with federal regulations, including HIPAA and ACA, while also focusing on areas requiring attention and improvement.
Efficient billing practices directly contribute to an improved patient experience. Streamlined billing operations enhance patient confidence and satisfaction, supporting overall quality care."
Our clinical auditors performs various types of medical chart reviews, such as inpatient, outpatient, radiology, DME audit, mammography audit, etc. We assess the quality of the care provided, the compliance with the coding and documentation standards, and the adherence to the clinical guidelines.
Risk Adjustment Data Validation
We can verify the accuracy of your risk adjustment data, such as diagnosis codes, hierarchical condition categories (HCCs), and risk scores. This can help you optimize your reimbursement, avoid penalties, and improve patient outcomes.
Data Abstraction Review
We extract and abstract relevant data from your medial charts, such as diagnosis, procedures, medications, lab results, and quality measures. We also verify the accuracy of data entry in your EHR or other systems.
Charge Validation
We review your charge capture process to ensure the charges billed to the payers are accurate and supported by the documentation in the medical chart. We also identify and resolve any undercharges or overcharges that may affect your revenue cycle.
A medical billing audit is a process that examines the health records of practices and reviews billing data submitted to payers to make sure the practice spots, supervises, and adjusts improper billing practices. Medical billing audits help evaluate the effectiveness and reliability of clinical documentation and the billing process. It is vital for a practice to perform regular billing audits in accordance with medical billing rules to maintain efficiency. Providers or the government usually ask for lab results, medical records, and financial records like charge sheets, payment schedules, etc
Doctors lose around $125 billion a year in revenue due to billing errors. A medical billing audit prevents these issues by verifying that the claims submitted to insurance companies are accurate and compliant with legal and health policies.
A medical billing audit is when experts review and inspect the medical bills and records to ensure healthcare providers bill for the right services in the right way.
Errors in medical billing can significantly impact a hospital’s revenue. A study found that the more complex billing strategies can add up to $99,000 per clinician.
CarePlusMB is dedicated to providing exceptional service and innovative solutions that help our clients thrive.
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