With the right process, billing and auditing patients’ accounts can be fast and stress-free. We’ve broken down the process of auditing a patient’s account into five easily manageable steps. Following these will let you streamline the process and make it more organized.
1. Confirm the Effective Insurance Dates
The first step is to confirm the effective dates of the insurance coverage. While doing this, look out for overlapping coverage. If that is the case, you might have the option of submitting the claim to the secondary insurance. This would likely apply for a specific time of service.
This is also the time to confirm that you are sending each claim to the right insurance carrier. This can be a challenge with overlapping coverage and other situations. It’s especially common to accidentally label an original claim as “insurance inactive.” When this happens, you can miss the timely filing limits of an insurance carrier.
2. Review Treatment Plans and Notes on Each Date
Once you have the effective insurance dates, it’s time to look at each date of service. For each of these, review the treatment plans as well as the notes. Check if any special payment plan or other discount that the patient may have been promised.
3. Get Copies of EOBs for Each Service Date
Next, you will want to get copies of the EOBs for every single date of service. This lets you confirm that your team properly submitted all procedures on the EOB. It also lets you confirm that the fee you submitted matches your UCR.
4. Cross-Check the Amount Paid
Now, it is time to make sure the patient made the right payments. Confirm that the amount paid indicated on the EOB is the same as the payment on the ledger. Then, confirm that these are the same as the payments in the bank records.
5. Verify Out-of-Pocket Patient Costs
Finally, you need to confirm the out-of-pocket costs of your patients based on the EOBs. This is the time to check the merchant processor records and the bank records. This will let you confirm that you collected the funds.
Bonus: Why Do You Need to Audit Patient Accounts?
Now that you know the steps to auditing a patient’s account, it might be helpful to remember why this process is essential.
Regularly auditing accounts can improve your profitability by identifying missed payments or claims you failed to file with carriers. You can use audits to find incomplete or inaccurate billing practices that cause you to lose out on money.
On the other end of the spectrum, audits can also reveal unnecessary or unrecorded charges. This can help your patients financially and prevent future issues for your company. Regular audits can even help you improve documentation and get in good habits regarding billing.
Auditing a patient’s account is a good practice, as it lets you spot errors and maximize profits. These audits also help you avoid fraudulent claims and compliance issues, which cause even bigger problems. The process can be straightforward when you follow the steps above. Versa Solutions conducts hundreds of account audits per month FOR FREE for our clients. Millions of dollars has been recovered with our Patient Accounting service. Reach out to see how we can help by clicking here.