Why a Healthcare Audit for ENT Billing & Coding is Important

ENT Healthcare Audit BillingHow are things going with your in-house billing and coding at your Ear Nose and Throat (ENT) practice or clinic? While it has been a couple of years since the introduction of ICD-10, which significantly increased the medical diagnostic codes required for billing, some practices are still struggling to keep up. Use of healthcare consulting companies and online coding help has grown significantly. Medical insurance verification issues and rejected claims are on the rise not just due to ICD-10, but also as a result of other changes within the healthcare industry.

You might think that things are going well, but you could be sitting on a powder keg that is ready to implode, taking your medical billing department with it. It is important to understand that the goal of healthcare consulting companies like MD Pro Solutions is not to move you to outsourcing services but to provide the solutions that are best for you and your practice. While some clients do move to outsourcing, just as many others decide to stick with it and provide their team with training, education, and online coding help. The only way to take the proverbial temperature of your billing department is with a healthcare audit.

Getting Professional Help

While you might think that you could do a non-biased audit of your practice, you would be dead wrong. The best way to weed out minor issues that might be occurring before they become big and expensive problems is to hire an outside, third-party source. In-house staff might overlook something that they assume to be small with the intent of protecting a co-worker. However, even the smallest of issues can cost a practice thousands upon thousands of dollars in lost revenue or get them into serious trouble with the new regulations.

Many private practices, clinics, and other healthcare organizations are now turning to third-party healthcare audit providers like MD Pro Solutions to assist them with benchmarking their performance under the new regulations and requirements. A properly performed audit can identify issues with billing and coding, medical insurance verification, co-payments and deductibles, and record-keeping requirements. An unbiased outside party is essential to the success of any healthcare audit. This service can verify issues that you are concerned might be happening, identify solutions that can be employed to rectify the situation, and prevent problems from getting worse.

Validating Accuracy

The primary reason for performing this type of healthcare audit is to verify the accuracy of your in-house billing and coding staff. Even if you think that everything is going well, it never hurts to be sure. Sometimes having a new perspective from someone outside the office can provide a more objective view of what can be changed to make marked improvements under the new coding regulations. Randomly selected records are typically used to perform an evaluation throughout the auditing process unless a client specifically requests for a certain area to be focused on for the healthcare audit.

Auditors look for claims that are missed, under-coded, or over-coded that might impact quality scores. They also look for any variances that could impact revenue, such as changes made to primary or secondary diagnosis or procedure, which could also negatively impact scoring. Claims that receive queries for additional information are also looked at, as well as claims that appear to be coded properly that required no changes to be made. All of the data regarding the randomly selected accounts will be reviewed by the healthcare consulting companies to determine the effectiveness of in-house billing staff.

When Improvement is Needed

If everything is going well with billing and coding at your ENT practice or clinic, no further work will be required. However, if improvement is needed to boost revenue, reduce rejected or denied claims, and boost your overall quality score, MD Pro Solutions can help. Our team of highly trained and experienced consultants works solely within the ENT specialty, providing insight and solutions that can be used to your advantage. Whether your team simply needs ongoing training, support, and online coding help or if you need to regroup and make serious changes to ensure quality results, we can guide you through the process and provide you with the resources necessary to make it happen.

When you work with MD Solutions, you can expect results. Most ENT doctors and practices have been able to improve the success of their billing procedures, increasing revenue by at least 10 percent just in the first year alone. If you are interested in learning more about our healthcare audit and review services, give us a call at 508-946-1665. We can answer any questions that you might have and provide you with more information about our training programs, online coding help, and other professional services.