One of the most difficult aspects that practice managers and providers deal with is gathering the information needed to see if current processes are efficient and working as intended. This data is crucial for identifying areas of improvement and providing an overall better experience to the patient.

At CHRM, we leverage our expertise, technology, and data reporting abilities to find that answer for you. Once an area of opportunity is identified, we collaborate with your organization’s leaders to present those findings. CHRM works with your leadership to propose process improvements and education for your staff. Need to know if your work is being done correctly and efficiently? Contact CHRM Today!

Why Is Medical Auditing Important?

  • Discover problematic trends: Some of the most common problem behavior found in medical audits include under- and up-coding, unbundling (i.e. using multiple codes for a procedure when one would suffice), using outdated coding, and providing insufficient documentation. 
  • Enhance patient care: More accurate medical coding and other clinical practices mean that your team no longer has to spend their time dealing with claim rejections and delays. Instead, they can focus on what matters most — the patients. 
  • Reduce the chances of an external audit: No one wants governmental investigational auditors such as recovery audit contractors (RACs) or zone program integrity contractors (ZPICs) knocking on their door. Internal auditing by a practitioner trained in coding and compliance can help reduce this risk.
  • Ensure compliance: Systematic failure to comply with payer’s policies can trigger compliance audits, resulting in hefty fines and damage to your reputation. Internal medical audits can uncover improper billing practices, whether caused by error or employee fraud, before the government has to get involved. 
  • Protect the bottom line: Inaccurate medical coding leads to denied and rejected claims, which in turn lead to decreased revenue for your healthcare organization. Resubmitting a claim for reimbursement takes valuable time away from your staff. A medical audit can help you avoid further damage to your bottom line.
  • Provide professional development: Medical practice audits can be used as a form of education for your staff by highlighting problem areas and how they can improve them. Ineffective patient care is inexpensive and precludes the provision of other services. An audit can help you identify cost-saving areas that won’t affect the patient’s quality of care. In addition, medical audits send a clear message to your employees that, while errors happen, they have a duty to report them. 

Interested in learning more about how a medical audit can help your healthcare organization thrive? Get in touch with the CHRM team today!