Medical Billing Audit Analysis

A complete audit of the practice data for the current and previous year to determine the key performance indicators.

Eight point analysis 

    1. Charges analysis
      1. Active providers list of the practice
      2. Active facilities list of the practice
      3. Progress note incomplete report
      4. Monthly average patient visit count
      5. Delayed charge submission analysis
    2. Claim submission analysis
      1. Claim rejection analysis
      2. Pending claims analysis to identify the unbilled claims
      3. Last three months claim batches analysis
    3. Payment analysis
      1. Past three years charges and payment comparison 
      2. Past three years individual providers charges and payment comparison
      3. Past three years collection percentage comparison
      4. Past three years average charges and payment
      5. CPT units and payment analysis
      6. Past two years adjustment breakups
      7. Fee schedule analysis
      8. Monthly charges and payment analysis
      9. Insurance payment analysis
      10. Graphical payer mix summary
      11. Charges and payment comparison grouped by facility
      12. ERA/EFT status report
      13. Paid to practice address verification
      14. Underpaid and negative claims analysis
    4. Denial management
      1. Missed follow up claims report
      2. Detail denial report
    5. AR analysis
      1. Overall insurance AR aging analysis
      2. AR report grouped by insurance
      3. AR report grouped by primary and secondary insurance
    6. Patient statement
      1. Patient AR aging report
      2. Patient statement analysis
      3. Credit balance numbers
      4. Return to sender statement analysis 
      5. Negative balance claims list

Identify revenue leakages outlined below

  1. Incomplete medical records (unsigned, undated, missed CPT, missed diagnosis code, etc.)
  2. Unbilled claims
  3. Unresolved payer rejections
  4. Missed claim batches (Claims are not received by the payers)
  5. Timely filing denials
  6. Claims are paid with full charged amount
  7. Payments never received from specific payers
  8. Payments never received for particular services
  9. ERA/EFT are not activated
  10. Incorrect practice address with payers
  11. Improper denial management
  12. No proper followup 
  13. Less number of clean claims
  14. Sent patient statement with incorrect balance
  15. Incorrect patient address in the practice records
  16. Out of network denials
  17. Fee schedule not setup
  18. Payers are downcoded the billed CPTs
  1. Increase the practice revenue from 10 to 15%
  2. Increase the clean claims ratio to 95%
  3. Improve proper clinical documentation
  4. Identify inaccurate, incomplete, and inappropriate billing 
  5. Improve denial management and claims follow up
  6. Pinpoint the revenue leakage
  7. Provider’s network participation status 
  8. Identify not activated ERA & EFT

Here is the predefined plan of action to stop the revenue leakage

  1. 96% of claims paid in first 20 days
  2. Denied claims are followed up in 24 hrs
  3. Increase denial prevention not denial management
  4. Clearing house & insurance rejections are followed up in 24 hrs
  5. Charges & ERAs posted in 8 hours
  6. Claims are submitted to the payers in 24 hrs
  7. Appeal denied claims to reverse the payer decision
  8. Insurance claims follow up starts from the 10th day from the claim submission date
  9. Weekly and daily report to identify the revenue leakage

ABC needs full PMS access to complete the audit analysis. The audit analysis pricing starts from $800 to $2,500 depending upon the practice volume and requirements

    Schedule a call for Audit Analysis