Using Chart Audits to Reduce Billing Errors

How to Do a Medical Billing Audit

Doctor and patient talking
Eric Audras/Getty Images

Even the most diligent medical office staff find it challenging to ensure they prevent billing errors. Incorporating a chart audit process in your day to day operations allows you to detect and correct these inevitable occurrences before they affect your bottom line and delay your claim reimbursement.

The fast pace of the medical office is the ideal environment for these mistakes.

Your office staff is doing the best they can to still offer excellent customer service. As with anything else, when times are chaotic, something will slip through the cracks or an error will be made. No matter how much you express the importance of accuracy to your medical office staff, you can’t just stop there. The chart audit process could be the difference between being paid as early as 10 to 14 days instead of 45 days.

How to Do a Medical Billing Chart Audit

The simplest way to audit charts is by creating a checklist. Be sure to include information that could cause denials or delay payments. Simple inaccuracies can make a big difference.

  1. Is the patient’s name spelled correctly?
  2. Is the patient’s date of birth and sex correct?
  3. Is the correct insurance payer entered?
  4. Is the policy number valid?
  5. Does the claim require a group number to be entered?
  6. Is the patient relationship status to the insured is accurate?
  1. Does the diagnosis code correspond with the procedure performed?
  2. Does the procedure code match the authorization obtained?
  3. For multiple insurances, is the primary insurance accurate for coordination of benefits?
  4. Is the Physician NPI number on the claim?

This is just a short list of examples. There are many things that could be included in your checklist.

It can also be more specific for the specialty of the practice, the type of facility, or the type of claim form used.

Frequency of Medical Billing Chart Audits

The minimum frequency should be yearly, according to the American Medical Association. Select a single day from at least three months ago to audit. Pull the patient account details for that day.

If possible, review five to 10 random medical records per physician or five or more records per payer (Medicare, Medicaid, insurer). You may need to review more than one day, depending on the size of the practice.

The medical billing audit should be performed by both the physician and the staff for the best results, according to the American Medical Association.

Review Your Claim Denials

Also be sure to review your denials. Use it as a tool to educate employees. Most likely they don’t know they are doing anything wrong if you continue to see the same trends. Make a spreadsheet of your most common denial reasons and use that as your guide to creating a checklist.

Share the Findings of Your Chart Audit

Once the chart audit is complete, share the findings with all employees.  All employees can benefit from each other.  This way all employees can avoid making the same mistakes in the future.

Assure your staff that the goal is not to point fingers and assign blame, but to recognize that errors occur. Note that errors can occur due to the information from the providers as well as from the front-line staff.

Ask for Suggestions for Improvement

Ask for suggestions from your staff on how to prevent making errors. Your front-line staff may have suggestions on how to change registration forms, capture changes in patient information, and ensure that providers give accurate information to use for procedure coding.