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

Companies 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 pronouncements.

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 Expectations

Communication 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 realistic.

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 minimized.


4. Third-Party Support

Hopefully, 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!

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