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Billing Audits & Management

Why Medical Billing Audit Services Matter in Healthcare

A medical billing audit is an organized process that reviews and examines documents administered by a medical practice in order to ensure accuracy. This process investigates the reliability of a practice’s documentation, which includes thoroughly checking all health records and medical billing data submitted by the providers. Medical auditing entails conducting internal or external reviews to make sure you are running an efficient and liability free business; however, auditing can be considered a ‘defensive measure’ where a government or private payor denies a series of claims and now wants copies of medical records and documentation in support of the claims. 

Most providers are worried about being tasked with a high-volume audit due to the extensive amount of work that the audit process entails. There are several ‘audit avoidance’ strategies that can be very effective at mitigating your practice’s chances of being audited by payers. With the surge of technological advances within the medical industry, more audits of providers are being done than ever before. Audits take time and resources that you may not necessarily be prepared for, therefore it is important to come up with a strategy to manage this effectively and prevent medical billing audits by any means necessary. 

Acme Billing Solutions’ medical billing audit services make it so that your focus can be on providing care to your patients. We are here to help manage your audits and prepare your practice with strategies that will help minimize the number of audits you experience with our professional billing audit services.

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How Acme Medical Billing Solutions Avoids Audits

Here at our medical billing company in Orange County, we understand that your primary goal as a medical practice is to focus on providing quality care for your patients while also being fairly compensated for your work. There are numerous ways our experienced team of experts at Acme Billing Solutions can help with regards to billing audit services. We will be in charge of implementing these methods so your practice can continue focusing on providing your patients with the best medical care possible. Our expert support is available to your business to ensure that your practice avoids unexpected, overwhelming, and time-consuming documentation audits. 

We are a full-service medical billing company that was created to offer healthcare providers the medical billing processes needed to maintain a steady flow of income and manage a successful practice. We want to ensure that you are well prepared for the possibility of an audit, and to also help you avoid being audited frequently. We understand that a lot of the time you are overworked and understaffed, therefore unable to transcribe documentation quickly and efficiently without taking time away from your practices. For this reason, we want to help you plan, prepare, and avoid medical billing audits. 

Acme Billing Solutions has a team of highly trained employees who are dedicated to working with you to create a customized audit avoidance plan that helps you understand your data, your documentation, risks, modifier usage, and unbundling. This ensures your documentation is up to audit standards and helps you avoid the possibility of being flagged for audit by payers and CMS.

5 Ways Acme Will Help Your Healthcare Business

Acme Billing Solutions begins all relationships with first identifying where the areas of loss exist and where there are opportunities for growth.
Our team will work on crafting a unique billing strategy that will allow you to see maximum results through new billing & utilization processes.
Once we have your strategy set, Acme Billing Solutions will assist in setting up new programs, software, and processes that will allow your healthcare business to thrive.
Once we have established your new billing practices, we will work tirelessly to ensure that your new billing strategy continues to allow your business to grow.
Thanks to years of experience in the healthcare industry, Acme always stays up to date with the latest insurance and billing practices to ensure your business is always complying with local and federal regulations.

Customized Healthcare Billing Audit Services in
Orange County, CA

An audit by an insurance company can be a costly and stressful situation for your practice, which is why Acme Billing Solutions’s medical billing audit services work with you to avoid medical billing audits year after year. 

Some of the ways we help you avoid an audit include:

  • Gaining an understanding of your data 
  • Knowing your denial rate
  • Overuse of modifiers
  • Understanding that time is money
  • Getting things right the first time around
  • Ensuring that everything is well-documented
  • Knowing where your patient is in relation to you
  • Under and over-coding
  • Unbundling
  • Obsolete coding
  • Knowing your place as a medical practitioner

Understanding your data by asking your coding and billing company to help run a report to compare your practice to other providers within your field of expertise is an action item that is highly important in audit avoidance. Differences in your billing system compared to other similar businesses could cause a loss of revenue down the line. It’s important to understand what you are charging in relation to other providers within your field. Knowing your denial rate is very important, and you can learn a lot about this by understanding the rate that your claims are getting paid. 

Overuse of modifiers is a common misconception that claims of yours will not get paid unless you append certain modifiers on the claims at all times. However, these modifiers should only be used if a certain criterion is met. Documentation is extremely important because if you did not document it, it did not happen. This can run you the risk of losing out on revenue and payment for a service. 

One very important tip is knowing where the patient is and where you are. This means that if you are not physically in an office space and you are providing someone with medical care, this could raise red flags. Under-coding is when the code billed is less expensive than the documented services, and over-coding is when the code billed is more expensive than the documented services, serving as another red flag for an audit. Unbundling is needed to stay informed about the latest codes used by your specialty. Obsolete coding is when billing professionals are responsible for keeping up to date with the changes of code sets. 

Lastly, knowing your place means that you understand that if you have any inaccuracies in billing, you can be fined or could potentially face jail time. Through our expertise in healthcare billing audit services, we help you avoid these situations at all costs.

Acme Is A Full-Service Billing Company Serving:

Urgent Care

Hospitals & ER

Behavioral Healthcare

Ambulatory Surgery

Clinical Labs

Private Practice

Insurance Billing Solutions That Don't Just Work, They Show Results.

Our medical billing services in California work with you to help keep you on track with your billing processes, which include medical billing audit services. We assist in audit avoidance by ensuring your practice is covered and acting in accordance with payers, and to make sure you are prepared for the day that an audit does take place. Our mission is to support your business with best practices when it comes to billing, utilizations and collections in a collaborative manner. Our goal is to give you the feeling of an in-house team billing team. 

As experts who have plenty of experience with billing solutions, we understand that billing practices can make or break a healthcare business. We are here to ensure that nothing goes wrong when it comes to billing. Acme Billing Solutions is here to help you stay current with the latest trends and policies as well as to help guide you and your team to success.

Find out why Acme Billing is the right partner for your healthcare business. Call and get a free assessment: 1.888.909.8055