E/M Coding Alert - 2008 Issue 32
Billing: Easily Evaluate Your Billing Procedures With Internal Audits
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Article Overview
This article covers the role of internal audits in evaluating billing procedures, coding compliance, documentation consistency, and denial patterns in a medical practice. It is aimed at billing staff, coders, compliance leaders, and practice managers who want a general framework for planning and conducting routine reviews. The discussion includes baseline assessment, audit scope, chart selection, supporting documentation, and other high-level considerations for internal review programs.
Why This Topic Matters
Internal review processes can help practices identify compliance risks, documentation gaps, and operational issues early, while also supporting more accurate billing workflows. The article is relevant to organizations that want to strengthen oversight and prepare for payer scrutiny without relying on external audit findings.
Article Sections
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Reap Internal Review Benefits
This section discusses the general value of internal audits for compliance, billing oversight, and staff education. It also addresses how practices may use review findings to identify broader workflow or documentation issues.
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Start With a Baseline Evaluation
This section explains the purpose of an initial baseline review and how it can inform future internal audit planning. It also discusses how review frequency may vary based on practice factors and audit findings.
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Follow a Checklist
This section outlines the major planning questions involved in preparing an internal audit. It covers audit scope, chart selection, documentation gathering, and the general review of denials.
What You Will Learn
- How internal audits support compliance and billing oversight
- Why a baseline review can guide future audit planning
- What broad factors to consider when defining audit scope
- How chart selection and documentation review fit into an internal review process
- Why denial patterns may be part of a billing review
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance officers
- Revenue cycle teams
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