Tip: An outside billing company may find problems you've missed Audit More Than Annually Doctors really need to be careful about scrubbing software that lets them know whether a claim is payable or not, says Liz Menduke, CHBME, owner of Primary Billing Services Inc. in Torrence, Calif. Check Claims Yourself If you decide to perform your audits in-house, take the following steps, Pemstein says: Have a Clearinghouse Check Your Claims If you want a second pair of eyes to check your claims, consider a clearinghouse. Hire an Outside Billing Service A third option is to hire an outside billing service to handle all of your billing or just perform your quarterly audits.
If you're not updating or monitoring the claims your billing software produces, you could be outputting claims with invalid - or worse yet, incorrect - codes. Prevent visits from the feds with these simple methods.
"Perform audits at least on a quarterly basis, if not more frequently," says Adrienne Pemstein, founder and owner of River Oaks Billing Service in Fair Oaks, Calif. "If you find an error, you want to make sure you catch it prior to the insurer's timely filing deadline."
Sonya Corsey, billing manager for Oral and Maxillofacial Surgery at the University of Pennsylvania Medical Center in Philadelphia, says the internal compliance department performs audits for them. The audits uncover minor problems, such as undercoding issues and some misunderstandings of the criteria for a new patient visit, she says.
"We do our own in-house auditing, and we've caught small things," says Bobbi Michaels, office manager for Oral & Maxillofacial Surgery Center PC in St. George, Utah. "Our electronic claims also go through our clearinghouse and they check to see if we've missed something."
A professional, accredited billing service will have internal audits in place and provide a new set of eyes to examine the claims, Menduke says. They're strictly monitored by the Office of the Inspector General billing guidelines and are more likely to have certified billing personnel who know how to perform audits correctly, she says.