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Medical auditing involves performing internal or external audits of the accuracy of codes policies, procedures, and policies to ensure that you run an efficient and , hopefully, risk-free operation. The quality of health care relies on the accuracy and completeness of medical documentation that is in the record. The best method to improve the quality of your documentation and the overall performance of your health care provider is to conduct audits of your medical records with outsourcing medical billing. They’re essential to identify areas that need improvements and adjustments. The objective of an audit is to ensure efficient and effective healthcare delivery and improve the financial performance of your physician. Outsource Medical Billing records specifically focus on and assess diagnosis and procedural codes as determined by medical documentation. 

Outsource Medical Billing

Many reasons exist for performing medical audits

  • To find outliers prior to large payers, spot them in their software for claims and ask for the internal auditor.
  • To safeguard against fraudulent claims and fraudulent billing activities.
  • To determine if there is an inconsistency from the national averages due to ineffective codes, inadequate documentation or revenue loss.
  • To assist in identifying and correcting problems before insurance companies or government payors contest inappropriate code
  • To stop government investigational auditors such as the recovery audit consultants (RACs) and zone program integrity consultants (ZPICs) aren’t knocking on your door
  • To correct under-coding, poor unbundling practices and code abuse, and to invoice appropriately for the documented procedures
  • To find reimbursement gaps and reimbursement opportunities.
  • to stop using outdated or incorrect codes to perform procedures.
  • To validate ICD-10-CM as well as Electronic Health Record (EHR) the readiness for meaningful use

Auditing medical records is lengthy, but the benefits outweigh the discomfort. According to the purpose, medical record audits could be conducted through an external organization or employees within the organization. Audits performed by an outside party are typically for the purpose of evaluating compliance. While internal audits are typically conducted to assess current treatment procedures and assess the quality of medical care.

The medical records of patients can be inspected in these easy steps:

Choose the Focus of Audit

In general, the goal of the audit should be to discover the practices of your hospital which are inconsistent or that require improvement. The audit process must be specific; measurable based on the information available within the records; crucial to the effectiveness of your hospital and to the treatment for your patients.

Define Measurement Criteria

Once you’ve identified the main focus of the review of medical records, identify the criteria to measure the audit. Next, you must determine what factors will determine if the criteria have been fulfilled. A literature review can assist in speeding the process because using methods that have been tested and proven to work will eliminate the need to create your own standards of measurement. Literature reviews also can provide benchmarks to compare.

Determine Which Records to Review

To determine which records you want to audit, it is essential to identify the exact patient population that needs to be assessed. Take into consideration gender, age, medical status, gender, and treatment regimen. ensure that all those participating in the audit are aware of precisely what factors determine the patient’s inclusion or not.

Decide Sample Size

Conducting an audit on each chart that meets your inclusion criteria is generally not possible and a common practice is to select around 10 percent of charts that are eligible to be reviewed. The significance of statistics is greatly affected by the size of the sample. If there aren’t enough records audited then the variables will be too numerous , and the results of audits will be of limited use.

Gather Data

Coordination of the audit’s details such as the date and time at which the audit will be conducted; the amount of charts that will be pulled, the names of the people affected; etc. Involve Medical records managers to assist obtain the charts and to ensure HIPAA compliance. Perform the audit and collect information.

Summarize Your Findings

This is essential because data that is not organized or relevant can lead to inability to utilize the audit findings to effect changes. Consider how the results will be utilized and then synthesize the information in the manner that is most beneficial.

Analyze the Data and Implement Appropriate Changes

Analyze the findings of the audit and determine the areas of improvement. For instance, if you observe certain methods for comforting patients such using a topical or local anesthetic prior to minor procedures in a way that is inconsistent, you could add these to the standard procedure. Additionally, you can make use of benchmarks that are already in place to guide your choices. Medical records audits can seem difficult, but the information that is contained in these documents can be extremely beneficial in increasing efficiency in hospitals and ensuring the satisfaction of patients. It is essential to make use of all the resources available to ensure the most pleasant experience possible to your clients.


Neeraj Kumar is a renowned health writer and expert with over 5+ Years of experience. Holding a diploma in Food & Nutrition, Neeraj Kumar is dedicated to providing readers with accurate, evidence-based health information to help them lead healthier lives. With a passion for Health, e.g., nutrition, fitness, and mental health, He has authored 50+ articles on different websites and platforms, which have helped countless individuals make informed decisions about their well-being.


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