Why Medical Auditing Is Crucial In The World Of Healthcare

In the world of healthcare, it is very important to focus on efficient and accurate documentation because without that the entire process of revenue cycle management could become obsolete – hence the role of medical auditing is crucial in any medical organization and for good reason. Medical auditing not only helps in understanding different areas which aid the practitioners on how they can improve their services but it also provides major benefits during medical billing and coding.

Clinics and hospitals can only provide the best healthcare to their patients if there is complete and accurate medical documentation in all of the records. Moreover, in order to improve upon the growth level and medical documentation of any healthcare institution for that matter, it is important to focus on the medical coding audit.

Understanding The Basics Of Medical Auditing

Medical Coding Auditor: What Is It? and How to Become One?

Auditing is a word that is commonly used in our day to day lives, many people are aware of it while many are not – whatever the case might be understanding the basics of medical billing auditing is key. 

The process of inspecting medical records in order to ensure that the medical facilities, pieces of equipment and doctors that are offered in a medical institution comply in a proper manner with all of the rules and regulations laid down by the healthcare administration are referred to as medical auditing. 

What Is The Role Of A Medical Auditor?

Benefits of a Medical Claims Audit · Reducing and preventing improper payments · Ensuring claims are submitted accurately

Medical auditors are an important asset to any hospital or medical organization. They conduct external and internal reviews and also ensure that the process of medical coding is accurate. They also make sure that all of the procedures that are being followed is being complied with the standard rules and regulations. This continuous scrutiny of medical coding is done impeccably by medical claims auditing companies which therefore ensures that the care that the patients are receiving is cost-effective in nature. 

Medical documentation will bound to have errors because of so many steps that are involved in it, therefore it is important to check every little detail before reaching the last step which is the process f claims submission. The work of medical auditors is to identify any the errors that could have occurred during the process of medical documentation. The loss of a physician’s license, accreditations or even medicare status are some of the errors that need to be looked after by the medical auditors. 

Moreover, they are also in charge of providing a proper perspective of the procedure that is required during the process of medical documentation and thereby provide all of the necessary details about the insurance guidelines and the medical coding rules and regulations. 

Advantages Of Medical Auditing

What is the importance of the auditing process for patients?

Auditing medical records have many advantages. Let’s take a look at what those are;

  1. When there are unnecessary coding and billing errors it always leads to the denials of the claim. The process of medical auditing aids in finding out and rectifying the issue before the insurance payers reject the claims on the basis of coding errors.


  2. If irrelevant medical bills are produced it will put a negative effect on the care provided to the patient or even the medical providers for that matter. The process of medical audits helps in preventing duplicitous medical billing and claims activity.


  3. Sometimes it might happen so that if a patient is getting the treatment for an illness they have they might not be charged for it. To put a halt to these fraudulent activities investigations and medical audits are necessary. Moreover, medical auditing further aids in avoiding these types of problems and also bill the appropriate amount for all of the procedures that have been documented earlier.


  4. One of the most important responsibilities that medical coders have is to investigate if there are any new codes that have been put out or not. This way every claim will have proper coding. In addition to all of that, medical billing auditing further puts a stop to incorrect use of codes for all the medical procedures.


  5. The process of medical auditing helps in the determination of any deficiencies that could have occurred in the process of reimbursement, thereby providing opportunities for relevant reimbursements.


  6. The verification of ICD-10-CM codes along with EHR (Electronic Health Records) becomes much easier with the process of medical auditing. 

Things To Remember Before You Audit Medical Records

There are certain things that must be considered when you audit your medical records.

  1. Deciding the focus of medical audit: The core purpose of medical audits is to understand the inconsistent medical practices that need to be made proper. Medical audits should be measurable, and specific and must be based on different data that are available in all of the medical records.

  2. Defining the criteria of the measurement: After recognizing the focus that is required for medical auditing it helps in deciding the definite criteria required for the medical review. Moreover, in order to reach a conclusion, it is also important to ensure that all of the criteria are met in a proper manner.

  3. Understanding the records that must be reviewed: identifying the patient populations that require evaluation will aid in selecting the records that must be included in the medical audit.

  4. Look for errors and reach an ending: The most important step when it comes to performing a medical audit is to look out for any other errors that you could have overlooked. With so much data that is included in the documentation process, it is important to reflect upon the discoveries that have been made along the way and therefore encapsulate the entire data in a proper manner.

When it comes to the process of medical records auditing it might seem like a long and arduous process, however, every medical practice must always focus on at least having one internal audit every financial year. The data that is included within the charts can be used for healthcare orderliness and also to ensure that the patients are receiving proper care. Companies like Synergy HCSL can help you with medical billing and other key aspects.