A Roadmap to Medical Billing and Coding Audits for Wound Care Providers

his article defines a medical billing roadmap for wound care providers to assist them in strengthen-ing the accuracy and completeness of their clinical documentation and in using evidence-based clinical practice guidelines to establish compliance with medical necessity and payer coverage policy requirements. In-house medical billing audits are useful for evaluat-ing compliance with payer policies and guidelines and federal and state law, identifying billing errors, imple-menting corrective action, and identifying areas where provider education is needed. A focused audit is risk based and examines either the where Thus, the of a billing frequently includes and/or ’ meet specific payer criteria.