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Medical Billing Audit – A Way to Optimize the Billing Process

Medical billing and coding services serve as the backbone for any medical practice. If the process does not go as per the latest guidelines, medical practices can suffer from an unstable financial situation.

Thus, to secure efficient revenue cycle management (RCM) and reduced accounts receivable (AR), healthcare organizations must consider medical billing auditing.

What is the Billing Audit?

It is a process that helps highlight the problematic areas in the clinical documentation of rendered services. The goal is to rectify those issues and improve the revenue cycle.

Why Medical Billing & Coding Audit?

Medical billing audits allow healthcare service providers to review their billing practices, coding semantics, and claim submission approach. It is a way to see if your system runs smooth or need an upgrade for improved performance in medical billing and coding.

Moreover, medical billing auditing also gives insights into the inconsistencies that might not be a problem at the moment but can be disastrous after a while.

Save Your Medical Practice from Penalties

If your medical billing and coding services are not compliant with HIPAA (Health Insurance Portability and Accountability Act), there is a chance of a government strike. They can penalize your medical practice if your billing standards are not up to the mark.

Thus, to improve the medical billing and coding standards and streamline the financial situation, billing audits are crucial.

Why Claims Get Rejected or Denied?

Medical billing audits are an opportunity to improve claim performance. Generally, claims get denied due to the following reasons.

  • Improper or false payment adjustments
  • Patient eligibility and verification issues
  • Wrong documentation of healthcare procedures
  • Lack of necessary medical information

There can be many other reasons that can make government or private insurance payers deny the claim. And, if you rectify the potential errors, you can have the following outcomes.

Advantages of Conducting Quality Medical Billing Audits

  • Improved coding accuracy as per the latest guidelines
  • Identification of the potential problematic errors
  • Enhanced reliability and transparency of the billing system
  • The streamlined workflow of your medical practice
  • Strengthened relationship between medical practices & insurance companies

These are just a few general examples of how internal and external audits can help you improve the revenue cycle.

Professional Billing Audit Upgrade System 

We cannot stress how risk analysis of the billing and coding process helps generate revenue. Administrative benefits, coding efficiency, higher claim acceptance rate, clinical benefits, thus, healthcare organizations’ performance owes to the auditing.

Thus, improvement in the medical billing services does not just enhance revenue generation. It also leads to improved quality and transparency in the following manners.

  1. With upgraded billing and coding practices, the claim compilation and submission process become smooth and instant.
  2. The cost-efficiency is improved as there remains no need to invest effort and time in processing claims again and again.
  3. The upgraded system is more reliable to generate timely reimbursements; the workflow becomes consistent.
  4. Data management and documentation become easy.
  5. We can design data-driven medical billing and coding strategies.
  6. A robust system allows a proactive approach towards the medical billing and coding services rather than being reactive (when some problem occurs).
  7. The analysis report helps to take strategic decisions & improve the quality of the medical billing and coding process.

Medical practices stay relevant with the latest billing and coding practices by removing vulnerabilities in the system.


The regulations have become stricter over time, and there is no margin for inappropriate or false services. Even if your medical billing and coding practices works fine, medical billing audits help to avoid mistakes, ensuring reliable revenue cycle management.

Thus, you become compliant with the government’s regulations and policies. Ultimately, the compilation of the claim gets effortless under an expert team.

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What Qualities Make A Good Medical Billing Service?

The more healthcare organizations are getting dependent on medical billing services, the more you are seeing medical billing companies in the industry.

With so many names in the market, it is difficult for medical practices to choose the right one for them.

Why Healthcare Organizations Choose Medical Billing Services?

Some physicians have a high ratio of claims sent back to them. While some suffer from inaccurate coding practices.  Some clinicians cannot deal with denial management or follow up services.

Low resources, untrained staff, inability to streamline cash flow, or whatever the reason is, the remedy for all these pain points is a professional medical billing company.

Professional medical billing services spend a lot of time and energy to compile medical claims to get clinicians reimbursements for the rendered services. The motivation to hire well-reputed medical billing and coding service providers comes automatically when physicians do not have sufficient cash at the end of the month.

Despite market research, many clinicians fall for fake promises of immature medical billing companies. Listed below are the top qualities that professional and experienced medical billing companies must have. Go through these checkpoints so that you do not do any mistakes while handling your billing, coding, and revenue management departments to a third party.

Specialty- Specific Medical Billing Support

Expert medical billing services submit medical claims as per the specialty of medical practice. They know your coding standards and billing norms so that the claims are not rejected.

For Instance,

The documentation requirements are different for specialty-based healthcare organizations from the general physician and assistant physicians.

P3 Healthcare Solutions is an experienced medical billing company for years and offers specialty-specific billing services to healthcare providers. The staff is trained with the latest billing and coding techniques to avoid major mistakes that restrict revenue cycle management. We make sure to implement strategies to minimize accounts receivable (AR).

Technical Ability to Compile Accurate Medical Claims

When healthcare organizations choose medical billing outsourcing, they expect a high return-on-investment (ROI), which is possible only when the chosen medical billing company tends to submit accurate claims to insurance companies.

Technical ability also refers to the deployment of equipment and software that reduces working hours to minutes. Such as Electronic Healthcare Records (EHRs) which is a secure way to save and transmit information across the network.

Developing a system for secure data transmission and streamlining revenue cycle management are the technical aspects that professional medical billing services master at first. Minimizing human errors by implementing interoperable technology speeds up the works and pinpoints the potential error areas.

Expert medical billing and coding services always look for technologies of state-of-the-art security protocols that lower down cost but increase efficiency.

Training and Educational Sessions for the Billing Staff

Training resources as per the latest standards is a smart practice to reduce errors and maintain the accuracy of medical claims.

Every year, you see a different set of billing guidelines and coding standards. To update knowledge of medical billers and coders is a must-have characteristic for successful medical billing companies.

By connecting with these medical billing companies, there is a high chance to earn more revenue. The ratio of denied medical claims reduces and productivity increases. It also maintains an air of transparent billing approach and the overall performance of the billing department improves.

Either a medical billing company is a grown one or a minnow, following upon the mentioned top three services results in tangible outcomes for physicians. A little investment is surely needed at the start but when you are able to increase reimbursement rate, it is worth a shot.


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U.S. Clinicians Spend 90 Minutes on Medical Billing Services

Recently the Journal of the American Medical Association and Medical Care published a report stating the time spent on EHRs by clinicians of several countries. The study particularly focused on the physicians, who prefer in-house medical billing services.

Research Background

The JAMA study compared the data of U.S. clinicians to those in Canada, Western Europe, Northern Europe, Middle East, and Oceania. Looking into their data, it was evident that clinicians in the USA spend more time in data management via EHRs (Electronic Healthcare Records) than other physicians do.

It was Harvard and Stanford University that collected the metadata of 371 ambulatory care health systems all around the world. All healthcare service providers with scheduled patient appointments and advanced practice practitioners participated in this study.

Statistically, U.S. clinicians spend ninety minutes on average for medical billing and coding services. While clinicians of other countries spend just an hour/day. Moreover, the Medical Care study also mentioned that it generally took 1.2 minutes more in the scheduled examination appointment for the primary healthcare services.

What to Take Away From This?

Both these studies suggest the inconsistencies in the EHR system and the inefficiency of clinicians for medical billing services. This time also lags other administrative tasks such as scheduling appointments.

The timestamps of the EHRs provided all the necessary data to review the time spent by physicians other than on patients.

The clinical activities included:

  • Notes
  • Orders
  • Clinical review
  • In-basket messages

Physicians’ data was judged based on the above-mentioned points.

It is also to consider that U.S. clinicians on average received thirty-four messages per day. Moreover, they spend a lot more time than the clinicians of other countries do on EHRs.

The Impact of Lagged Time on Patient Experience

The study also gave insights into the issues in appointment scheduling and patient experience. For Instance, short-time appointments are more likely to get delayed as compared to the longer ones. It is one of the major reasons that lead to burden down physicians. Ultimately, it also adds to poor communication with patients, resulting in unsatisfactory care quality.

Medical billing services are not clinicians’ forte. And, to help them in the process, it is necessary to lower down the administrative burden from their shoulders. That is why many physicians in the USA tend to outsource medical billing and coding services to others.

Administrative Load for Medical Billing Needs to Change

Journal of the American Medical Informatics Association also analyzed that women clinicians have to spend more time on EHRs than male clinicians. The time difference is estimated to be thirty-three minutes. Thus, this study is a reflection of the efforts that female healthcare service providers put into their work.


All in all, this study pointed out the inaccuracies in the U.S. medical billing services process. The best option for physicians is to outsource the administrative data to a qualified company.

Whereas, health IT leaders need to come up with effective solutions that are cost-effective and time-efficient for everyone. Only then, our healthcare industry will be truly progressive.