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What are Medical Billing Audits in Dermatology and How to Use Them

Does the word “Audit” give you nightmares? Here’s why your practice might actually benefit from a medical billing audit.

Dermatologists – we’re looking at you! Together with every team member in your practice, you do good things for people looking to enhance their skin, to have a problematic issue dealt with or to receive quality care for a dangerous medical condition like skin cancer. This is where you excel. It’s your area of expertise and people have come to rely on you. But – we have to ask – Are there some opportunities for improvement? Do you tremble at the mere mention of the word “audit?” We’re not talking about an audit of your finances and a visit from the government but, actually, yes we ARE talking about your finances and how to improve the overall financial health of your practice. How? By undertaking a medical billing audit (MBA). Trust us, it’s not as scary as it sounds!

Loosely defined – an MBA is:

  1. A medical billing audit closely examines and evaluates the effectiveness and reliability of your clinic records, as they pertain to billing practices.
  2. It’s a process that helps to identify, monitor and rectify billing practices for a variety of reasons including addressing compliance issues and opportunities to correct inefficiencies such as lost revenue from improper coding or not resubmitting denied claims.

Such opportunities are to your benefit as a dermatology practice as they may identify areas for you to either save money through efficiencies or earn money by correctly submitting and claiming all relevant reimbursements. Audits might also be initiated at the request of an insurance company to examine the medical necessity of a procedure or because of concerns about potentially fraudulent claims. These aren’t necessarily bad for a dermatology practice and still aren’t a reason for fear. They may simply result in greater efficiencies around appropriate data collection, gathering co-pays prior to procedures or by identifying gaps in your referrals processes or in the collection of a patients medical history. In short, if you look to audits for answers not as an attack, you’re bound to find opportunities not impediments. Don’t leave revenue on the table. View a medical billing audit as an integral part of the financial health of your practice.

Here’s what to expect when you’re expecting an audit:

  1. Determine the Who and the How.
    1. Who: Will you have someone internally complete the audit for you or hire a consultant? Both have merit but an outside consultant who only specializes in medical billing will have the most recent and up to date billing codes, full familiarity with the audit process, no “personal” investment in finding and correcting (or hiding!) mistakes and will be solely focused on the audit instead of multi-tasking both their day job and this additional responsibility.
    2. How: Will you undertake a complete audit of all patient records or only a representative sample? Will you want to check records from all insurance providers or have you identified a select few who are problematic? In other words, determine the scope of the project so you can plan the workload accordingly along with who should be doing it.
  2. What are you looking for?  You’ll want to pay attention to the frequency and inaccuracy of billing code errors. Are they the same errors over and over? Are the errors only with one provider? What about denials – are you seeing one provider consistently deny far more frequently than others? Have you under – or over – coded claims submissions leaving either money “on the table” or your practice subject to risk if a provider believes you are intentionally miscoding? Are you using billing software and is it up to date and accurate?
  3. Opportunities for change! Make sure, as we suggested moments ago, that you have a mindset of opportunity not opposition. Remember, a medical billing audit is about identifying problematic areas of your business in order to rectify them – maximizing the opportunity to earn the revenue you deserve – while respecting and following all the correct procedures. This is your chance to review your practice, make changes that just might improve your bottom line and which will even help to ensure you are ready should a payer ever wish to audit you. If you’ve already done the legwork, or hired a consultant to do it for you, such an audit won’t cause any angst. 

Another sure-fire way to prepare for an audit is to consider the services of a medical billing company like Derm Care Billing Consultants. Using a specialist service to take care of all your billing needs is the equivalent of having excellent advice available on speed dial, 24/7. Medical billing is ALL we do. We KNOW codes and we UNDERSTAND insurance providers, dermatology practitioners and all about accuracy and efficiency. We streamline the billing process virtually guaranteeing you savings. By choosing DCBC, you will reduce staff overheads & benefits, decrease errors and claim rejections, and increase cash flow. Oh and by the way – you’ll also never be afraid of an audit again! 

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