Inadequate oversight of medical billing and coding can cause your hospital to lose money. Further, it may invite extensive governmental audits of poor practices.
Accuracy in medical billing and coding deserves the best attention you can give, a matter you must take seriously. Improper codes in your billings can create outcomes that can damage your reputation. In addition, noncompliance with current federal regulations can attract the kind of attention you do not want.
Implementing a process that provides an organized accounting of your billing and coding practices can contribute to your hospital’s success and peace of mind. We offer a trusted service that many hospitals and healthcare facilities rely on for accuracy and transparency.
Put our highly experienced team on your side
Former Special Agent (OIG)
Former Special Agent
(FBI & IRS-CI)
Former Assistant Regional Inspector General
Former Supervisory Special Agent (DOD-OIG)
Director of Coding
Former Special Agent-in-Charge (DEA)
Former Special Agent (FBI)
Improving Compliance and Revenue
A report from the Office of the Inspector General of the U.S. Department of Health & Human Services revealed the results of one of a series of hospital compliance audits. The methodology used data analysis techniques, data mining, and computer mining to examine hospital claims at risk for not complying with Medicare billing requirements.
Citing the $206 billion paid to hospitals in 2017, more than half of all fee-for-service payments, the report emphasizes the importance of ensuring hospital compliance with guidelines. Our auditors can help you avoid some common pitfalls that generate avoidable errors.
A common factor in successful facilities reflects streamlined processes that support an organized and methodical approach to the business of healthcare. Some hospitals have relied on the wrong companies while others like you want to find a solution that works.
Whatever group you find yourself in, we offer a dedicated approach to helping your hospital achieve the greatest benefits from your success. Impediments that can slow your growth include these:
- Inefficient billing
- Potential liabilities
- Inaccurate billing
- Improper filings
- Lack of a seamless process in patient care
We provide a way for you to adopt modern business methods that offer patients a first-class experience and create no headaches for you.
Avoiding Fraudulent Claims
Our experience as a leading medical coding audit company can help you detect fraudulent claims and institute proven solutions before they occur. When you implement effective prevention, your hospital can avoid the legal backlash that can occur from fraudulent billings like these:
- Services Not Provided
Unfortunately, one of the biggest frauds in insurance occurs when practitioners bill for services that patients did not receive. An effective accounting system ensures transparency that lets you easily verify the accuracy of the bills that you present to patients.
A decision to bill for services individually instead of bundling them may let you get more pay from insurance companies. However, it can present a risk that can lead to a hospital billing audit and implications for your facility that you do not want to have.
- Uncovered Services
Insurance companies can refuse to cover some healthcare services that patients may qualify to receive. However, frequent billing of services in question can create doubt that makes them seem fraudulent.
Perhaps a little easier to detect than more complicated forms of healthcare fraud, upcoding occurs commonly. When a hospital bills for more than it provides by rounding up to half-hour segments unintentionally or not, it can trigger a hospital billing audit. A similar error can occur when billing occurs for a higher-priced medication than the generic version costs.
- Unnecessary Services
Adherence to ethical billing practices requires you to understand the services that your state plan includes. The requirements for each provider may vary, imposing a significant responsibility on you to know the differences. When you sign off to approve a billing document, you affirm the accuracy, medical necessity and completeness of the service your hospital provided.
Providing Training for the Best Hospital Billing Practices
A class or seminar in medical coding can help your staff become familiar with the best billing practices. However, it cannot deliver the in-depth knowledge that an experienced medical coding audit company can provide. The constant changes in the medical industry can make it difficult for anyone to stay informed about them.
On the other hand, a company that focuses on medical coding audits understands the issues you face. With the expertise that an experienced team of professionals can provide, you can achieve a level of training that helps prevent hospital billing audits. Many healthcare facilities want staff to receive instruction from a company experienced in medical fraud prevention to help curb the occurrence of liabilities whenever possible.
Seizing Opportunities to Enhance Your Practice Revenue
Chances to drive revenue to your hospital may lie within your grasp if you know how to recognize them. Some may seem obvious and almost impossible to miss, but they can occur all too frequently. For example, simple oversights like these can deprive your facility of the revenue it deserves.
- failing to resubmit denied claims
- miscoding claims
- improperly billing for services or supplies
Our hospital billing audit can reveal the discrepancies that may escape your attention and help you drive revenue to your hospital.
Aligning Billing Policies with Current Laws and Regulations
While keeping up with changes the government makes to laws requires vigilance and constant attention, they affect your hospital nonetheless. In addition, the changes to billing regulations by insurance companies can directly affect your revenue stream. Further, revisions to billing codes that occur regularly complicate the process of staying well-informed.
Your ability to adopt billing practices that reflect these changes can help secure your success. We understand the difficulty of managing the administrative complexities of delivering health services while providing patients with the best care possible. Our professional medical billing audit can identify areas that seem lax and develop recommendations to improve them.
We assure you of complete compliance with laws, regulations and codes while our expertise helps enhance your revenue.
Choosing Exceptional Guidance from a Team of Experts
Our credentials assure you of the knowledge and experience required to avoid hospital billing audits. Our founder, a federal attorney with in-depth billing compliance expertise, set stringent performance standards that guide our work. Consequently, we assure you of the compliance that you can rely on to protect you from intrusive government hospital billing audits.
Detecting Potential Trouble Areas
Our vigorous approach to reviewing policies and procedures can give you an independent view of your office functions. Outdated processes that become familiar with time may allow time-consuming problems to occur. We offer an intervention that detects weaknesses in your compliance programs, and we recommend the best way to correct them. Our approach provides options that meet specific needs.
- clinical level
- financial level
- policy-specific level
Our extensive experience in providing high-quality medical billing audits allows us to serve healthcare facilities of all sizes.
Providing the Essential Components of Medical Billing Audits
The vital areas of compliance apply equally to small clinics and large hospitals. Organizations of all sizes and descriptions have chosen us to provide the best solution to compliance issues. Our customized approach to medical billing audits can meet the specific needs of your facility.
Finding Weak Billing Practices
New rules that started in 2022 require healthcare facilities, insurance companies, plans and practitioners to provide protection from surprise medical bills. We stay fully abreast of laws that affect our clients.
Auditing Medicare Patient Charts
We examine the components of your payer reimbursement processes to make sure they comply with federal and state guidelines.
Discovering Missed Billing Opportunities
Charges that your staff missed billing can deprive your hospital of deserved payments.
Detecting and Eliminating Potential Liability Issues
Our hospital billing audits detect and alert you to the potential for risk of liability.
Avoiding the Risk of a Hospital Billing Audit
Whether you expect to receive a medical billing audit or want to eliminate the risk of one occurring, we can provide the assistance you need. Our reputation for providing the most thorough and effective medical coding audits establishes us as a leader in the field. We honor a commitment to serve our clients in every aspect of the complex healthcare environment.
Our record of success stands on our development of processes that deliver results with a superior level of service. Our staff of experienced federal investigators, compliance lawyers and expert billing auditors gives us an edge in resolving issues that may vex our competitors.
When you choose us, we study your hospital’s processes and learn how things work. We assess and evaluate our observations to provide a basis for making the improvements that can lead your facility to increased revenues and profitability. You can rely on us to provide relief from the risk of a billing audit, giving you peace of mind and enhancing performance. Reach out to us online or call 866-808-4160 to schedule an appointment.