A medical auditor is a person who reviews medical records and billing data to confirm that bills were dispensed properly. The purpose of the medical auditor is to improve quality and billing accuracy and to help to catch billing mistakes that can lead to under billing and other related problems. Individuals who are interested can train to become medical auditors by taking training classes in medical billing and coding. Pursuing certification through a professional organization is recommended in some areas, as it can increase employability.
Medical auditing is seen as a critical piece to compliant and profitable physician practices. Whether it’s simply for financial reasons or just peace of mind, more physicians have regular audits done on their billing practices throughout a fiscal year. For medical professionals the risk for malpractice and other risks, are getting far too big to not be compliant with documentation and coding.
The medical auditor compares a billing record with a patient's chart. If there are irregularities, such as billing codes for things not recorded in the chart or entries in the chart for procedures that were not billed, the auditor flags them. The auditor also looks to determine whether or not appropriate billing codes are being used for various procedures, office visits, consultations, and tests.
There is education and training to become a Certified Professional Medical Auditor, which will give you a solid foundation and good knowledge of coding and documentation guidelines to improve your or another practice's financial situation.
Certified Professional Medical Auditors have a good understanding of the following:
• Knowledge of medical documentation, fraud, abuse, and penalties for documentation and coding violations based on governmental guidelines
• Coding Concepts
• Scope and Statistical Sampling Methodologies
• Medical Record Auditing Skills and Abstraction Ability
• Quality Assurance and Coding Risk Analysis
• Communication of Results and Findings
• The Medical Record
There are several reasons why an audit may be required or recommended for a medical institution. The work assigned to a medical auditor is confidential in nature as it involves personal patient records, and medical auditors must observe strict ethical practices while they work. A medical auditor could be part of a quality improvement team working to identify the strengths and weaknesses of a given facility, an internal employee who randomly selects things for review to maintain quality, or an employee of a government agency or insurance company who verifies billing information.
Above all the profession of a medical billing auditor is meant foe someone who pays great attention to detail and can recognize discrepancies in numbers and documents quickly and efficiently. The training and education will build on this foundation, leading you to become a success medical auditor.