Health Information Management

Explore pre-bill audits to help reduce instances of rebilling and recoding

HIM-HIPAA Insider, April 27, 2015

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Conducting pre-billing audits can be challenging, but when done correctly, it can save organizations from spending time recoding and rebilling claims that payers deny. These audits can be conducted on the front end, in both inpatient and outpatient settings, once records have been coded.

"You're coding and auditing the entire account before it goes out the door," says Christi Roberts, RHIA, CCA, director of operations at Woodham HIM Solutions in Tequesta, Florida. "You're decreasing the chance that it's going to kick back."
Healthcare organizations are conducting increasing numbers of pre-bill audits, both internally and externally, says Monica Pappas, RHIA, president of MPA Consulting, Inc., in Long Beach, California. These audits offer the opportunity to increase the percentage of clean claims submitted by an organization, which can help reduce erroneous claims that raise red flags with payers, says Pappas, an MRB editorial advisory board member.
In the inpatient setting, the primary focus of pre-bill audits is often limited to ensuring claims have the correct MS-DRG code assignment and appropriate complication codes, says Robert S. Gold, MD, founder of DCBA, Inc., in Atlanta. Outpatient pre-bill reviews tend to focus on medical necessity. "Not enough pre-bill audits are directed to the patient, and in today's environment, this is the most important focus," he says.
Continue reading "Explore pre-bill audits to help reduce instances of rebilling and recoding" on the HCPro website. Subscribers to Medical Records Briefing have free access to this article in the May issue.

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