7 Benefits of Auditing your Medical Billing Expenses


In any business across industries, auditing plays an important role. It acts as an excellent tool for ensuring proper revenue management cycle, adhering to regulations and laws, to identify the scope of improvement in the internal processes. This is definitely true when it comes to physicians, particularly with medical claims.

Medical audits cater to two ways to enhance operations at a medical practice. The primary auditing begins with the claims administrator. The second one is self-audit of operations within your own practice to identify the areas of mistakes and how improving from those mistakes can bring a difference.

Dealing with medical claims is quite complicated and costly if not well-managed. Some factors that medical claims may require audits are finding errors in medical billing, finding methods for improving recovery opportunities, and ensuring a medical practice is adhering to the recent compliance regulations governing medical claims.

Before we look into the benefits of auditing in medical billing, let us know the types of audits performed in medical billing.

Medical Billing
Medical Billing

Types of medical claim audits

Medical claims and medical billing audits can be conducted no matter what the size of your organization is. Performing regular audits can keep your medical billing system streamlined and with sufficient cash inflow.

The following are the types of audits performed in medical practice:

Random Sample audit

In this audit, claims are picked according to the insurance money covering both large and small claims are audited. It throws more focus on the dollar amounts rather than the number of claims involved. A random audit does not get you money refunds from insurers directly but can help to move to a comprehensive auditing review.

Comprehensive audit

This audit has a more immense scope and looks at a group of audited clams prior, both electronically and manually. It gets you to claim refunds from claims administrators, which is the comprehensive audit’s ultimate objective.

Hybrid audit

A hybrid audit is the combination of random sample audits and comprehensive review audits that achieves the results of both factors, such as the recovery of money and compliance to regulations. Moreover, it focuses on the quick recovery of over payments.

Benefits of a Medical claims audit

A self-audit is not officially incorporated by the federal government but only encouraged by the CMS.

So, according to CMS, a medical practice can experience the following benefits due to medical claims audits:

#1: Reducing and preventing improper payments

Audits can have a check on your regular and irregular payments and can guide you on how to make a move for further transactions with your claims partner. It helps identify the reason behind delays in claims reimbursements/medical billing systems and gives you a clear picture of improvements and best practices. This definitely helps you with reduced payment issues and prevents insufficient funds inflow in your medical practice.

#2: Ensuring claims are submitted accurately

Since audits help check every nuke and corner of medical billing and claims submission, your future claims get progressed without any rejections from the insurer. When claims are submitted accurately, your revenue is also enhanced, resulting in patient satisfaction.

#3: Enhancing patient care

Regular audits support you in receiving quick reimbursements and improved focus on patient care who visits your medical practice. When there is no hassle in medical billing and claims processing workflow, you can run your operations more efficiently with spending more time for your patients.

#4: Reducing the chances of external audit

If your internal medical audits are sufficient to provide the scope for improvement and point out messed-up areas, there is no need for you to spend time and money, allowing external audits.

#5: Instant feedback on staff performance

Internal medical audits give an opportunity for you to identify the good/poor performance of the staff and instruct them on their areas of improvement instantly. It also provides accountability of errors to your staff so that they work more responsibly.

#6: Cost-benefit and compliance

Audits help your practice figure out the areas where you can pull your pending or slowed-down money from and introduce new policies and procedures to avoid the mistakes made previously by your staff. Thus audits offer benefits both cost and compliance-wise.

#7: Training on weakened areas

Since internal audits help you understand how efficient your staff is in terms of medical billing and claims services, they can be provided proper training on areas where they find it difficult.


All your internal audits can be made easy by partnering with 24/7 Medical Billing Services, one of the leading medical billing and coding outsourcing partners. You need not break your head on documentation and other audits related work, since we handle your patients’ data highly secured.

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