Professional medical auditing
Quality health care is based on accurate and complete clinical documentation in the medical record. The best way to improve your clinical documentation and the livelihood of your health care organization is through medical record audits. They are necessary to determine areas that require improvements and corrections.
The goals of an audit are to provide efficient and better delivery of care and to improve the financial health of your medical provider. Medical record audits specifically target and evaluate procedural and diagnosis code selection as determined by physician documentation.
Basmart Health is well aware that the losses in the healthcare services market come from poor auditing, and there are some medical facilities or cadres who exploit it for illegal gains at the expense of losses of contracting institutions.
The medical auditing process must control the negative effect of the dual role of some physicians as agent for the patient and as service provider in public and private hospitals and medical centers, and measuring the extent of incurred losses in health economics system in funding agencies.
Studies have shown that there have been heavy losses for medical insurance companies, and this has also drawn attention to the specific roles in the operational process in the medical care market, which means the human role in service delivery.
One important finding of the study: that there are some non-professional medical practices by some doctors, which lead to increased treatment costs without medical or scientific justification, causing huge losses to medical insurance companies and contracting parties to treat their employees, which adversely affects the health economy system and all efforts In this regard.
There are many reasons to perform medical audits
- To determine outliers before large payers find them in their claims software and request an internal audit be done.
- To protect against fraudulent claims and billing activity.
- To reveal whether there is variation from national averages due to inappropriate coding, insufficient documentation, or lost revenue..
- To help identify and correct problem areas before insurance or government payers challenge inappropriate coding.
- To help prevent governmental investigational auditors from knocking at your door.
- To remedy under coding, bad unbundling habits, and code overuse and to bill appropriately for documented procedures.
- To identify reimbursement deficiencies and opportunities for appropriate reimbursement.
- To stop the use of outdated or incorrect codes for procedures.
- To verify electronic health record.
HOW CAN YOU APPROACH TO OUR AUDITIG VALUE?
You can first contact us to evaluate our medical audit capabilities, and we also have a team to conduct the audit on behalf of your organization.
It is also possible that you need Basmart Health in the process of checking a disputed file and issuing an approved report.