Internal vs External Audits for Busy Otolaryngology Practices

One of the requirements for medical practices and clinics is to establish a medical billing audit plan. Regardless of the size of your practice, this is something that must be done. The option and debate, however, is whether your audit should be performed internally or externally for best results. A practice with just one physician might feel that internal auditing is the most practical, helping to save money on hiring an external service to perform the healthcare audit. However, there are clear advantages to using outside services from reputable providers.

The Benefits of Auditing
The goal of any audit is to identify issues and help make improvements. In the medical world, there are lots of different audits. Audits designed to improve billing and coding, an annual fee schedule review, offside CPA audits, and general healthcare audit services. When it comes to claims audits, there are two types that can be performed: prospective and retrospective audits. You don’t need to choose between the two, in fact, both should be performed regularly. Prospective audits are performed before claims submission, while retrospective audits are performed after the claims have been submitted and paid.

The two most common areas of any medical practice or clinic that are tested by a medical billing audit are coding and billing documentation. Regular audits can help to spot small mistakes or errors before they become big and costly problems. If a bill is coded improperly, revenue could be lost. If bills are overcoded and generate more revenue than they should, by law the money must be returned to the payer. If the Office of the Inspector General (OIG) discovers overcoding is occurring, the practice could ultimately be fined and put on review. Sometimes small mistakes, such as having inaccurate patient data or transposed numbers, can also cause claims to be denied. An audit can uncover these types of mistakes.

Why External Audits are Best
Even in the smallest of practices, things can get hectic. In fact, it is in smaller practices where employees will most often wear multiple “hats,” taking care of reception work, billing work, and back office management at once. While we might always think that there is time to perform an in-house healthcare audit, there usually isn’t. Companies like MD Pro Solutions, which specializes in providing professional services to Otolaryngology practices and clinics, help medical professionals to take care of things like an annual fee schedule review, training and education, medical insurance verification support, online coding help, offside CPA audits, and other types of monthly and annual healthcare audits.

Another huge advantage of using an external auditor is that an outside service will not have any biases with regard to staff. They can be more objective and therefore more likely to discover issues like upcoded or undercoded bills. Experienced auditors do this for a living. They are trained to do this on a daily basis. The recommendations that they provide are paid for, so they are more likely to be taken seriously than recommendations provided by co-workers who perform an internal audit. In addition, other services can also be performed by a professional provider to help keep a busy practice or clinic in compliance. Assistance with policies, procedures, training schedules and support, can all help to make noticeable improvements.

Trust MD Pro Solutions for Auditing and More
When your office hires MD Pro Solutions to perform an external audit or provide professional consulting services, a variety of reviews and healthcare audits will be provided. We have found that the best way to improve account management for our clients is to start by performing a complete audit, not just of the medical billing and coding practices, but of the entire facility. Our team will work directly with your staff to implement important changes and make improvements to your Otolaryngology practice.

We will also create a system for periodic reviews and audits to ensure that you are staying on track with the advice that has been provided. Annual chart and surgical chart auditing, an annual fee schedule review, offside CPA audits, medical insurance verification reviews, and other related healthcare audits are just some of the ways that we help keep everything under control. To learn more about MD Pro Solutions and the wide array of professional services available to ENT practices and clinics, give us a call at 508-946-1665 and speak with one of our friendly customer service agents.