A post-bill audit, also known as retrospective audit or claims audit, is a process of reviewing and validating previously submitted healthcare claims after they have been processed and reimbursed. The value of a post-bill audit lies in its ability to identify and rectify errors, ensure compliance with regulations, and optimize revenue for healthcare providers.
Here are 5 key benefits and values associated with post-bill audits:
- Error identification and correction: Post-bill audits help identify errors and discrepancies in coding, documentation, and billing practices. By thoroughly reviewing claims, the audit process can identify coding errors, incorrect billing of services, or other discrepancies that may lead to overpayments or underpayments. Correcting these errors can help improve compliance and ensure appropriate reimbursement.
- Compliance assurance: Post-bill audits play a crucial role in ensuring compliance with healthcare regulations, payer policies, and coding guidelines. By reviewing claims against the applicable rules and regulations, audits help identify potential compliance issues, such as unbundling of services, improper use of modifiers, or inaccurate documentation. Addressing these compliance concerns can mitigate the risk of audits by regulatory bodies and potential financial penalties.
- Revenue optimization: Post-bill audits help optimize revenue by identifying missed revenue opportunities and underpayments. By evaluating medical record documentation and reimbursement received for each claim, audits can identify cases where reimbursement was not maximized due to coding errors, incomplete documentation, or improper billing practices. Correcting these issues can result in additional revenue for healthcare providers.
- Process improvement: Conducting post-bill audits provides insights into the overall billing and claims submission processes. By analyzing the trends and patterns identified during the audit, healthcare providers can identify opportunities for process improvement, such as staff training needs, documentation deficiencies, or areas for automation or streamlining. Improving these processes can lead to more accurate and efficient billing practices.
- Risk mitigation: Post-bill audits help mitigate the risk of potential financial losses and reputational damage associated with non-compliance or improper billing practices. By proactively identifying and addressing errors, audits reduce the likelihood of audits, investigations, and penalties from regulatory bodies, payers, or enforcement agencies.
It’s important to note that the value of a post-bill audit is dependent on the thoroughness and expertise of the auditing process. Engaging experienced auditors, whether internal or external, who possess knowledge of healthcare regulations, coding guidelines, and payer policies, is crucial to maximizing the value derived from the audit process.
BESLER’s Auditing Services will help ensure successful reimbursement for your hospital.