Audit Risk Monitoring

Some practices today are hesitant to bill payers for the services performed or consistently bill for services based on higher fee schedule. There is nothing wrong with billing for services performed with the right level of documentation and medical necessity. Unfortunately, there are providers that continue to bill at a higher level when there is no medical necessity to collect larger payments. These providers are possibly billing for services fraudulently and abusing the system. This is a fine balancing act. Medicare, commercial payers and RAC auditors are proactively looking at outliers.

This feature allows practices to monitor audit risks, perform internal billing audits and focus on providing a better quality of care.