Why you must perform Internal Medical Insurance Audits

by | Sep 24, 2013 | Business, Financial Services

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Your medical practice may be losing revenue every time you receive a claim reimbursement. Why? Because most medical practices do not think to question the amount of money they receive for each claim. Performing internal medical insurance audits is the only way to be certain you are receiving the maximum amount allowed for your claims. When outsourcing medical billing, third party billing companies will do this regularly as part of their billing regime.

Daily Lost Revenues
If you allow the money you receive for each claim to be accepted blindly you may be losing money everyday due to claims that have only been partially paid. As well many practices allow for delayed claims to go unchecked for months resulting in lost revenue and do not even think to question when claims are denied. Arranging for internal medical insurance audits will keep you abreast of the status of claims as well as allow staff to be prepared to challenge claims that are denied. When outsourcing medical billing they do this automatically.

Insurance Tactics
Insurance companies know that many practices are negligent in follow up when it comes to claims. This means that for every claim they under pay, delay or deny, they stand to earn as they know they will not be questioned. Underpaying is easy as many accounts receivable departments will simply look to see a payment was received, record it and move on. Delays are often ignored until it becomes too late to demand the claim and denials are often vague yet most practices do not challenge denied claims. This saves insurance companies millions of dollars a year simply because so many practices do not audit their own claims.

How to Prepare for Audits
You can take the following steps for your internal audits:

  • Assign a staff member to be responsible for the audits
  • Have monthly insurance reports reviewed for status, payments and delays
  • Review explanation of benefits
  • Investigate reasons for denials, delays and underpayments
  • Prepare supporting documentation to prove your case
  • Prepare claim appeal letters and resubmit claims
  • Maintain records in a log book to follow status of all claims and reclaims
  • Collect and watch revenues grow

When outsourcing medical billing your third party billing company will handle all of these steps for you. If you are on your own making sure someone is delegated to run monthly internal audits will drastically increase your practice’s revenues.

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