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2 min read

Billing Company Audits

If you contract with a medical billing company to manage your accounts receivable, do you audit and monitor their work?

Maybe your cash flow is steady, adjustments seem accurate and in line with your monthly averages, and your A/R days are within the range of industry standards. This would imply your billing company is doing a decent job at collecting your revenue. While these KPIs provide a great high-level observation, they don’t tell you if your billing company is working optimally and compliantly across the revenue spectrum to collect on your behalf.

To ensure your revenue cycle is operating at peak level, from both a reimbursement and a compliance perspective, a deeper dive into your billing processes is necessary. Here are some questions to consider when evaluating your billing company’s performance:

  • Do you sample and audit denied claims regularly to see if appropriate and timely action has been taken to resolve them? We recommend doing this at least quarterly, but if you can do it on a monthly basis, even better!
  • Are denied claims appealed and if they are, are they based on documentation, CMS guidelines, and/or payer-specific coverage policies?
  • Do you cross-check paid claims against your contract agreements to ensure payers are processing claims accordingly and paying the agreed-upon rates?
  • If your billing company is coding or appending modifiers to claims, are they coding correctly and based upon the documentation? Do they have an auditing and monitoring process in place for their coding practices? If so, do they share the results with you?

Many billing company contracts are based on a percentage of collections, so they are incentivized to collect as much as possible. We find most are reputable vendors who place compliance at the forefront of everything they do; however, you really can’t be sure yours is up to par unless you’re auditing and monitoring the work they do.

You may be thinking “Who has time for this?” and the answer is, we do!

The Rybar Group is uniquely qualified to take this on for you. Our experienced revenue cycle and coding teams partner with healthcare providers to perform not only documentation and coding audits, but also billing audits to review the entire Appointment to Zero-Balance process (aka A-Z Process).

Not only do we work with healthcare providers in performing billing audits, but we also work with billing companies directly reviewing billing and claims processes across all of their clients. This offers a unique marketing edge for them with prospective clients as it demonstrates a commitment to the highest quality work product with compliance at the forefront.

For more information on how The Rybar Group can help you with a billing audit, contact our team today.

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