As affirmed by the Medical Billing Advocates of America, 8 out of 10 medical bills contain errors that cost insurance companies and patients money. Billing audits are one strategy to fix this problem. Billing Audit is an organized process which inspects and evaluates the effectiveness and reliability of clinical documentation and medical billing data submitted to the payers. Data sources to conduct billing audits consist of Clinical, Financial and Policy related documents.

Audits can be conducted either the before claims are sent out to the payers (prospective) or after the fact (retrospective). Billing Audits are a lot more extensive in degree than Coding Audits and cover all the claim submission process areas, medical billing life cycle starting from insurance verification processes, follow-up processes, payment posting process, and denial management process.

Billing audit is a complex task where many things can go wrong. It takes a seamless, highly efficient system to conduct medical claims processing without critical errors. Even minor mistakes can spell trouble for healthcare providers, insurance companies, and patients. Billing audits may sometimes appear to be a luxury, especially in a very bustling practice; however, there are various convincing reasons why performing audits is beneficial. Those benefits cover clinical practice as well as administration.

Billing audits may in some cases appear to be an extravagance, uniquely in a bustling practice. However, there are various convincing reasons why performing reviews is helpful.

As billing becomes more complex, a deliberate and strategic approach to billing audits will be necessary for every employer. Establishing best practices for your audit processes will help ensure that your measures get the most out of the time put in your audit efforts.

This project’s main objective is to help the insurance company eliminate carrier invoice errors and properly allocate benefit costs amongst all of the unique employee cost centres.

It is nearly impossible to fully audit carrier invoice by a company because of all the employees, adjustments, divisions and codes on the invoices. Therefore, they came up with an idea to provide this online service to audit the data.