9 Important Medical Billing Audit Checklist

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A medical billing audit is done to ensure that the patient is receiving services that are covered under the insurance plan. The process involves reviewing all the bills submitted to the insurance company and verifying that the services were provided and that the charge is reasonable and necessary. There are few steps involved in medical billing audit checklist which are mentioned below. n

Medical Billing Audit Checklist

nThe audit checklist helps to provide a general overview of the billing process. It helps in determining if the biller adhered to all the steps of the billing cycle, as required by the regulations. While this list is by no means exhaustive, it should provide you with a basic outline for ensuring accuracy on your medical billing. By following these guidelines, you can help ensure that your bills are properly documenting the services that you provide to your patients.n

Patient Record Verification

nWhen auditing medical billing records, it’s important to verify that all pertinent patient information is included. This can be done by reviewing patient charts and/or by contacting patients directly. This will help ensure that your medical billing system is accurate and compliant with all applicable regulations. You may find that the billed services do not match the services actually provided. This can lead to billing discrepancies and potential fraud.n

Provider Information Verification

nIn order to verify the provider information on medical billing audit, it is important to have a list of the provider types and their corresponding information. This list will help to ensure that all of the necessary information is included on medical billing audits. The verification process begins with verifying the provider name and contact information. Next, it is important to verify the type of service provided, including any applicable fees. If any discrepancies are found, corrective action must be taken to ensure accurate provider billing.nnAlso Check:n


Is the correct date of service being billed?

nWhen reviewing medical bills, it is important to ensure that the correct date of service is being billed. This can be difficult to determine, as dates may be subjective and may not always reflect the true date of service. nnFor example, a bill might list the date of service as “8/5/2021” when in reality the service was actually performed on 8/6/2022. Similarly, a bill might list the date of service as “2/11/2016” when in reality the service was actually performed on 2/12/2022. It is important to verify the correct date of service when auditing medical billing records.n

Are services being billed for what was actually provided?

nAre services being billed for what was actually provided? is a key question to ask when auditing medical billing. By using a variety of techniques to assess medical billing records, auditors can help ensure that services are being billed appropriately and that fraudulent activities are prevented.n

Duplication Verification

nThere are several factors that can affect the accuracy of medical billing records. Poorly written or formatted invoices can lead to errors in calculation or reporting, while incorrect information on claims can be due to mistakes made by patients, providers, or both. Audit checks also may reveal fraudulent activities – such as overcharging for services – that could result in financial losses for hospitals and other healthcare providers.n

EHR Verification

nEHRs can also be susceptible to fraud and abuse. For example, inappropriate or fraudulent billing may occur if information in an EHR is falsified or inaccurate.nnTo help ensure the accuracy and integrity of EHRs, healthcare providers should verify the data in an EHR against official medical records. Healthcare providers can use a variety of verification tools to check the data in an EHR against official medical records. This process is also important in Medical Billing Audit checklist because by verifying EHR you can find all mistakes and error in bills.n

Diagnostic Report Verification

nIt is necessary to verify the correct diagnosis and to identify any discrepancies between the report and the patient’s medical records.nnIf a discrepancy is found, it may be necessary to investigate further in order to determine if the discrepancy was caused by an error on behalf of the healthcare provider or by something outside of their control. n

Documents on prescribed medications Verification

nThere are a number of documents that must be verified when auditing a medical billing claim, and this includes any documentation pertaining to prescribed medications. This includes the patient’s prescription, any related paperwork (such as an authorization form), and the actual medication(s) themselves. nnWhen verifying these documents, it is important to ensure accuracy and completeness. Any discrepancies may indicate that the claim was not accurately billed or that fraudulent activity took place. Additionally, if any of the documents are missing or illegible, this may also signal potential fraud or improper billing.n

Codes assigned and formats used Verification

nProper verification of codes assigned and formats used can ensure accurate billing and accurate payments. The Medical Billing Audit Checklist (MBAC) is a tool that can help to verify the accuracy of codes assigned and the formats used in medical records.nnThe MBAC was created as part of the Medicare program to help identify billing discrepancies, fraud, and abuse. The checklist includes questions about codes, modifiers, quantities, dates, etc. It can be used by physicians, hospitals, health care providers, insurers, and others involved in healthcare reimbursement.n


nHope you have read all process of Medical Billing Audit Checklist. If not then you should read carefully this article. Because it will help you a lot to auditing medical billing. If you are looking for medical billing service for your practice then you can call us at (888) 598-9181 or email at info@med-miles.com. For any issue you can contact us.

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