Importance Of Medical Post Payment Audit

It is necessary for all health insurance payer to regularly monitor their coding, billing, and documentation process done by the health care providers. This is necessary to make sure that there is no cases of fraud and abuse within the health care payment system. The insurer would request all the medical records from the provider in order to carry out the auditing process. After which all the documentation would be compared on the claim forms that were previously submitted and paid

Under the best medical post-payment audit process, the department can only approve the medical documents that are less than $1,000 and without any requirement of prepayment auditing by the Payment Services. The documents approved by the department are then audited for compliance with payment rules on a post-payment basis — however, payments amounting to $1,000 or more are needed to be pre-audited.

Some of the reasons why payment services need medical post-payment auditing are explained here.

1. To make sure that all the supporting documentation is collected for each payment.

2. To statistically sample the transactions by the vendor, object code, or unit.

3. To spot or identify any type of coding errors, particularly for entertainment and controlled items.

4. To minutely evaluate the expenditure trends using the object code and variances.

5. To find the departments that need additional training.

6. To verify that all payments are made according to the relevant state laws.

7. To verify that the assets are in their intended locations.

Therefore, to avoid any fraud or mistakes in the payments or documentation, it is essential to hire the best medicare post-payment audit service, provider.