MedsIT Nexus offers a fool proof solutions for auditing medical claims by combining verified audit procedures, knowledgeable personnel, and the most reliable analytics technology.
Specialties Served
Net Collection Rate
Days in AR
Hour Claim Turnaround
Increase in Cash Flow
Specialties Served
Net Collection Rate
Days in AR
Hour Claim Turnaround
Increase in Cash Flow
MedsIT Nexus medical billing audit services involve the systematic assessment of physician practices
within a healthcare organization. A medical billing audit can be performed on the various components
within the organization. Still, most commonly audit is performed on the elements concerned with the
insurer reimbursement process to assess whether the billing and coding implications for physician
practices comply with regulatory authorities’ regulations and guidelines.
Although your front office can perform audits manually, It is a big challenge for them to understand and
recognize the thousands of CPT codes for the rendered service. Additionally, your front office is
partially aware of the physician’s specialties’ procedural coding complexities; hence their manual and
self-practices lead them towards typos mistakes. It results in the submission of a false claim.
Ultimately, medical providers are overwhelmed by their practice’s revenue irregularities and losses and
put their organization at risk of extensive audits by the government.
When you outsource your claims audit to a renowned medical billing company such as MedsIT Nexus, we make the billing process easier by acting as a mediator between your specialties and an insurance company. Before sending claims to the insurance company, it is processed through the software where the automated rule engines are applied to identify mistakes that would lead to the denials. But the MedsIT Nexus goes beyond claim scrubbing and uses our clearinghouse partner’s preferred scrubbing tool; this catches errors far better and faster than humans.
Additionally, our automated claims scrubbing services ensure that medical professionals eliminate the technical complexities of the claims processing and spend maximum time in patient care to adhere to the state of law.
MedsIT Nexus CRM department provides free consultation to your healthcare organization’s concerned authorities. How in-depth you will perform the internal auditing process for the medical claims you have prepared to submit is decided. Yet, taking a more meticulous approach will result in better (and more actionable) solutions.
MedsIT Nexus delivers medical billing services to clients comprising a detailed audit with the following process.
In the first stage, our auditors conduct internal or external reviews of medical records for coding accuracy, policies, and procedures to ensure an organization runs efficiently.
After the medical claims review, our auditor will determine whether we will use a prospective or retrospective strategy.
At this stage of our company's standard process, our auditors check billing reports, charges, codes, and other censorious records to maximize cash flow and reduce claim denials. We follow the following recommendations at this stage.
In the regulatory compliance practice revenue cycle management process, If the detailed report identifies any issue that could result in errors and claim denials, our company auditors identify areas to correct them within the shortest period. If our client disagrees with the audit results, they can challenge the findings within 60 days.
MedsIT Nexus has in-house highly skilled and professional billing auditors having experience of several years in the medical field. As we provide our services to physicians all over the United States, our experts utilize their enormous capacity to provide dependable medical billing audit solutions to medical practices.
An audit tool is essential when auditing the medical record. At MedsIT Nexus, our auditors utilize audit software to audit records, print an audit report, and help analyze the data.
MedsIT Nexus practice revenue experts perform a comprehensive analysis with auditors to apply complete practice revenue cycle processing to examine the practice's current financial health and operations. Our professional’s close-checks the entire process and identify critical points and a comprehensive solution for resolving them.
Our practice revenue and audit experts in the medical billing department audit claim rejections for medical practices and identify deficiencies that cause denials. After reviewing the denials carefully, we resubmit the claims with corrective actions resulting in maximum reimbursement.
We compile the audit findings in a concise audit report. We categorize our audit reports in detail yet persuasively so the reader can understand what was audited and how the audit was performed. Identify the number of encounters documented correctly and incorrectly. Note trends and errors in coding. Each error or risk area should be outlined and labeled to define the category (for example, particular CPT® code, payer, provider, or specialty). All errors should be explained and include a citation to the appropriate standard.
Our auditors discuss the findings to address risks and the corrective actions to mitigate them. A physician may be less concerned with coding and compliance and more concerned with patient care, so we present the report to both the physician and the front staff. Our reports outline each category and let staff know what they did well and how they can improve. If they require any specific training, we provide them with our expertise.
Our company maintains security and compliance measures keeping emails and passwords encrypted to protect the content and attachment of the email when it reaches unintended recipients.
Periodic reporting about payer denials is maintained to monitor and record patterns in potential billing and coding errors. Moreover, it guarantees that proper follow-up is taken. These reports can also be used for account analysis.
MedsIT Nexus experienced training team keeps medical auditors updated about the changes and updates in existing regulations by conducting training sessions periodically.
OIG, the Centers for Medicare & Medicaid Services, the Department of health & human services, and AAPC are included as the compliance reference resources because these enterprises provide educative articles, auditing software, notifications about upgrades, and compliance concepts.
The process involves the assessment of the claims ensuring they are submitted in compliance with Local and National Coverage Determination and insurer guidelines..
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