About Audits: The Revenue Cycle from the Blog

Is your plate overflowing as you try to juggle all the components of your ASC? Chances are, some things slip through the cracks because other things demand your attention. Often times, billing practices fall to the wayside and are considered good enough simply because cash is coming in.

What if we told you your money was missing?

It’s true – if your billing practices have been left to fend for themselves, you may be missing out on key cash opportunities due to common billing mistakes. Some examples may include:

• Incorrect patient information
• Incorrect Provider information
• Incorrect Coding
• Mismatched Medical Codes
• Duplicate Billing
• Undercoding
• Poor Documentation
• Missing/unposted EOB
• Short payments

When mistakes – be it one or multiple - are happening simultaneously within your billing office, payments are delayed, and your revenue cycle doesn’t run smoothly or effectively. By auditing your revenue cycle, you can uncover issues within your A.R. process that may be preventing you from getting paid the full amount for your ASC’s healthcare services in the quickest time possible.

A revenue cycle audit should look at your billing from start to finish – from scheduling to insurance verifications, to coding and charge entry, payment posting and all standard follow-up. By looking at each aspect of the revenue cycle, you will be able to pinpoint where the kinks lie and work on implementing changes more effectively.

Does a revenue cycle audit sounds great, but you don’t know where to start? Take a look at our suggestions to prepare for an audit, whether internal or external:

• Make as many items as possible electronic.
  • Often, it can be difficult to pull all the documentation needed to support coding or EOBs to support how the claim was paid and posted.
• Have a high level understanding of every step of the revenue cycle and who completes it.
  • This helps to quickly answer questions the auditor may have.
    • Example: Who applies adjustments? How do they know what to adjust? Who drafts refunds? What does this process look like? Where is documentation from the coder saved for charge entry?
• Have revenue cycle-related policies and procedures available for the auditor in advance.
  • If you don’t have these drafted yet, start with common policies such as your small balance write-off policy, expectations for how quickly cases should be coded, charges entered, payments posted, and follow up completed. When should contractual adjustments be made, who is approved to make adjustments and any limits to the amount each position can adjust without approval.

Whether your revenue cycle feels like a mess, or something just feels the slightest bit *off*, a revenue cycle audit will be a great fit to find the pain points within your billing practices. Our team is ready to step in and help bring efficient and effective billing practices back into your ASC – reach out today and let’s chat! Give us a call at 1(855)208-5566 or email us at info@in2itive.org.

Is your revenue cycle up to par, but your coding is falling through the cracks? Learn more about our coding audit solution here.