The purpose of the audit is because claims are being submitted to the payers 30 days after the patient’s visit. The expected time for claim submission is within 14 days of the visit. A plan will be prepared to decrease the number of days between the patient visit and claim submission.
The measurement to determine the accuracy of claim submissions will be measured by reviewing the submitted bills from the billing department in the last 30 days. This will outline the goal of the audit process which is to achieve 100% of claims to be submitted within 14 days of the visit.
The medical billing department is responsible for the number of days between patient visits and claims submission. The billing staff must change the current procedures to decrease the current turnaround time. The audit process will consist of claims submitted in the last 30 days.
A claims analysis checklist will be used to see if the staff of the billing department had adequate information to complete the submissions on time. Some questions that will be addressed include whether or not the department received the appropriate claims right after each patient visit. Another topic addressed will be to determine if the department was fully staffed during the last month.
In the audit process it is vital that all medical records support each service provided by the physician and ensures that each service was medically necessary and reasonable. Also part of the process is ensuring that the patient’s chart documentation is appropriate to the billed services and comparing the frequency data of the Medicare E/M with the physician’s E/M frequency data.
To follow-up on each claim that is not accurately processed a health information manager will be assigned to address the employee that the mistake was completed by and train them the proper procedures for submitting the claim. A meeting will be scheduled to