Medical Auditing: 4 Best Practices To Follow

Two person audits the medical charges and bills by seeing the report

Are you ready to boost your practice revenue? Conducting regular medical billing audit will be very beneficial for your healthcare practice. In this article, we share with you the 4 best practices for medical auditing to ultimately improve your practice revenue in 2021.

1. Review
The Previous Medical audit To Identify Risks

The first
step to prepare for a medical audit is to review your organization’s last
medical audit with an eye for issues cited and correct those in advance. Next,
identify areas of risk. These can include accounting for complex areas such as
equity and debt arrangements, revenue recognition, and IT systems and controls.

2. Assemble
Your Internal Team And Evaluate Needs

must also take a realistic look at internal teams and determine if external
help is needed. Review your staff before a medical audit begins to make sure
the right skills and experience are in place. A key internal position needed to
support a medical audit is that of the controller. The person in this role coordinates
and manages all medical audit activity. If the controller doesn’t have a strong
skill set, then the likelihood of having issues with your medical audit
increases significantly. In a larger organization, there may be someone who the
controller designates to help offload some responsibilities.

It is also
helpful to consult with your external medical audit partner to determine if
they expect any complexities with the medical audit that may require seasoned
external help. They may recommend using resources to deal with the complexity
of highly technical accounting areas or implementing newly adopted accounting

The accounting department’s workload is higher at the end of the year than at any other point in time. Not only are they closing the books for the year, but they’re also preparing for a medical audit. Companies may need to bring in resources to help manage the additional workload. These additional people can take on some of the most time-consuming activities, freeing up employees to focus on medical audit preparation.


3. Set

should be clear and frequent with all participants as medical audit preparation
is underway. Communicate with the engagement team, your company team, and
external resources (e.g., banks and attorneys) regularly. Schedule frequent
status meetings between the medical audit firm and company personnel to
determine progress and address any issues. Regularly confirm that the
deliverable of a signed medical audit opinion on the required date is still

Request a timeline from the medical auditors that includes deliverables and milestones. Start with the previous listing of schedules “prepared by the client.” The medical auditors need access to information that they will test or evaluate following their medical auditing program. To facilitate this, they will request several items from the company in the form of a “prepared by client” schedule.

For example, they might request accounting records, trial balances, account reconciliations, various accounting reports, significant agreements, and board minutes to carry out these procedures. Schedules should be prepared in the form requested to improve the efficiency of the medical audit and potentially reduce medical audit fees.

The goal is
to minimize surprises for your company’s leaders. Because regular communication
is required for an effective and efficient medical audit process, status
meetings should be scheduled in advance. This is the only way to monitor that
expectations and schedules are being met and to quickly identify and resolve
accounting issues. Scheduling regular communications allow your company to
control the medical audit process, which will help control costs. Just as
critical is that there is an expectation that both your company and the medical
auditing firm will come to the meeting prepared for a productive discussion.

By having a
frank conversation at the start of the medical audit process about expectations
and issues, the medical audit will start on the right track, and issues will be


Third-Party Support

you evaluated the firm and its work after your company’s last medical audit (if
not, schedule an annual evaluation). Review the evaluation to get reacquainted
with the team, including overall quality, responsiveness, consultation process,
communication habits, quality of recommendations, understanding of the
company’s business, and, importantly, results versus expectations. An
evaluation review provides an opportunity for both sides to discuss process
changes or restate respective needs, priorities, or expectations.

Commit to
the long term with the external medical auditors. It’s generally
cost-prohibitive to switch medical audit firms, even when, ostensibly, it’s
being done to save fees. Companies will find they end up spending more,
considering the time it will take a new firm to ramp up or if the new firm
brings different processes or evaluations and assessments that internal staff
did not prepare for. That is not counting the additional expense of time and
resources to find, research, interview and select a new firm.

Effective planning in advance and consistent communication throughout the medical audit process can ensure that your company’s medical audit runs smoothly and efficiently. The best way to run a smooth medical audit and improve your revenue cycle management is to contact the best medical billing service provider, CapMinds – schedule a free demo with our billing experts today!

About The Author

Author: Pandi Paramasivan

Pandi is the founder and CEO of CapMinds, a cutting-edge healthtech company dedicated to empowering individuals to take control of their well-being. Under his 13 years of leadership, CapMinds has completed more than 100 healthcare projects that include customization and integration for OpenEMR, HL7 FHIR, Mirth Connect, Telehealth, Remote Patient Monitoring, Connected Health, and more.

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