Benefits of a Medical Claims Audit

In businesses across all industries, an audit is an important tool for ensuring the proper management of money, adhering to regulations and discovering areas where internal process improvements can be made.

For physicians, this is especially true in the area of medical claims.

In general, there are two areas where claims audits can improve operations at a medical practice. The first is an audit of the claims administrator. The other is a self-audit of operations within your own practice to determine where mistakes are being made and where improvements can make a difference.

Medical claims are complicated and costly if not managed correctly. Generally, a claims audit of any kind can:

  • Find errors made in medical billing
  • Find methods for improving recovery opportunities
  • Ensure a medical practice is adhering to the latest (and often byzantine) compliance regulations governing medical claims

There are a variety of options and benefits of a medical claims audit.

Types of Medical Claims Audits

An independent audit of how your claims are handled by the claims administrator can identify problem areas in both lost monetary opportunities and compliance with regulations.

Such an audit also sends a clear message to your administrator that you are committed to taking an active role in the process and also to making sure every dollar is spent wisely and within guidelines.

This is an important stance to take as errors often occur. For example, the Centers for Medicare and Medicaid Services (CMS), a