For a physical therapy practice owner, there is probably nothing worse than the fear of a billing audit. Therefore, It is always preferable to avoid an audit. You might be able to avoid a billing audit with the help of the following checklist. Alternatively, if an audit is imminent, using this list or collaborating with an outsource medical billing and coding company may help you be ready for it. A Medical Billing Audit is a systematic review of compliance and quality at a healthcare facility. The audit process includes every area of running a practice, but the most important component in the physical therapy medical billing audit checklist is the reimbursement process.
Purpose of Physical Therapy Medical Billing Audit :
The objective of physical therapy billing audits is to withstand continual examination by federal auditors and insurance providers. Periodic audits are the best defense against government and insurance company investigations at a medical facility. By evaluating the claim data and generating risk reports, healthcare institutions may discover their compliance lapses and any suspicious billing trends. In the absence of such measures, such errors might cost the doctor dearly in the form of federal prosecution, financial fines, criminal penalties, and removal from insurance networks.
The medical billing audit is expected to guarantee that the hospitals deliver high-quality patient care and that the providers are informed about documentation requirements. A good medical billing audit checklist may thoroughly examine the facility’s revenue cycle management and optimize it to ensure that the correct payment is made for each service. Additionally, it gives you the ability to defend yourself against malpractice lawsuits, health plan denials, and audits from public and private insurance providers.
Here are some of the updated physical therapy medical billing audit checklists for 2022:
Checking and Verification of patient records and provider information:
You must verify patient IDs and authorizations while creating a medical billing audit checklist. The information entered on the demographics chart, such as surname, date of birth, date of service, date of visit, location of service, etc., must be confirmed and cross-matched with the claim papers. Additionally, it is crucial to confirm that the patient’s insurance plan was active and legitimate on the day of service listed in the documents.
It is important to check into the specifics of both the provider that provided the service and the provider who issued the bills. It is also important to confirm that the provider mentioned in the documents has the appropriate licenses and credentials according to state regulations.
Validation of electronic medical records (EHR)
According to the physical therapy medical record audit checklist, cross-reference all identifiers, confirm that the correct dates have been entered for all visits and procedures, examine the clarity and credibility of the data, assure that the patient’s medical history has been recorded accurately, and determine whether or not it contains information on allergies, serious complications, drug and food interactions, smoking, alcoholism, and substance abuse, among other things.
Examine any accidentally added duplicate records.
It is also important to check the codes and bills, as well as the history of paid and denied claims from this healthcare provider for the same service date. It is necessary to determine which codes were paid and which were rejected in the prior claims. Has the service provider divided the bills for the same day of service into multiple claims? Such items must be carefully examined during the audit.
Completion of medical history and physical examinations
Check that the right chronology is maintained in every patient contact, medical examination, and follow-up appointment documentation. Medical billing checklists emphasize clear and thorough records on all of the primary care therapist’s findings, including a summary of the patient’s health conditions.
The comprehensiveness of the diagnostic and treatment strategy
The final diagnosis and illness condition is the focal point of the medical billing audit checklist since they serve as the foundation for the treatment plan. It is essential to evaluate if the treatment plans were compatible with the diagnosis and whether the summary reports from the specialty consultants, lab results, imaging, and scan reports were documented with the other records. These results should correspond with those of the physician to ensure that everything is in order.
Procedures carried out in detail
Every record on the date and kind of operations performed, as well as information on the provider, material list, and amounts utilized for the procedure, must be examined. The audit checklist for medical billing requires informed consent information to be documented and signed by the patient, and the relevant provider. It should be determined whether the patient’s full vaccination records and information on any missed or canceled previously planned appointments are contained in the paperwork.
Confirmation of assigned codes and format usage
The most crucial component of medical billing checklists is the verification of billing documents for conformity with coding standards. There are several code details that must be reviewed. Always ensure that the correct CPT/ICD codes are utilized on claims. Additionally, confirm that the codes allocated to the claim are consistent with electronic health records and that the diagnostic codes used are as detailed medical evidence.
You may rely on Medcare MSO for the physical therapy medical billing audit checklist if you’re having trouble with your billing audit. We are equipped with the proper tools and seasoned auditors to probe into the core of your billing procedure and identify any potential risk concerns. With the assistance of intelligent software and trained auditors, We may enable you to eliminate all the potential financial and legal hazards in your practice.
Call us today in resolving the common problems with reimbursement and ensuring that you get the highest possible revenue.