Just a Yearly Task? Just like a home, the more you put off simple maintenance tasks the more it will cost you. HIPAA requires daily, weekly, monthly, quarterly and yearly maintenance tasks. Depending on the size of the practice, these tasks may be delegated to a single individual or shared among staff members. If you…
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During the audit process, you probably noticed that it all comes back to documentation. A provider should code from the documentation. That means that the procedure code, all modifiers, and the ICD-10 code(s) are based on the documentation (medical record). An Explanation of Benefits (EOB) may be processed by the payer based on procedure code…
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Audit the Appeals Process When developing corrective actions after the EOB audit, you might want to take a closer look at the clinic’s appeal process. KMC University recommends the following steps whether the clinic is filing a formal appeal or a quick and easy request for reprocessing. The compliance officer may want to use these…
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Auditing Leads to Action You might be wondering why we have included additional information on appeals in an EOB audit training. As stated before, each audit should lead to corrective actions. We all can learn from our mistakes. In order for a compliance officer to be able to develop corrective actions that are appropriate, they…
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Download Support Tool The EOB Audit Tool
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The Intent of an EOB Audit? For a practice that participates in 3rd Party Reimbursement activities and accepts assignment of benefits, the best indicator of whether you are being paid what you deserve is the Explanation of Benefits that accompanies payment. This important document shares not only the adjudication of your claim for payment but…
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