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How to Conduct a Successful NEMT Billing Audit: Tips and Best Practices

Are you looking to conduct a successful NEMT billing audit for your business? Whether you’re new to the process or looking to improve your current approach, we’ve got you covered. 

In this blog post, we’ll share valuable tips and best practices to help you ensure a successful NEMT billing audit. We’ll guide you through the process step-by-step, from understanding the importance of an internal audit to implementing effective strategies.

Keep reading to learn more and take your NEMT billing to the next level!

What is NEMT Billing Audit?

NEMT billing audit is a structured procedure that involves a careful review of documents to ensure they are correct. The audit examines the accuracy and effectiveness of the detailed documentation of the NEMT company. It includes a thorough check of all health records and billing data submitted by the billing company.

The NEMT billing audit process will carefully examine all available data and records. The audit team will detect, track, and fix any billing practices that are inaccurate, incomplete, or inappropriate.

The audit can also detect potential compliance issues. These issues could ultimately impact the company’s profits or result in penalties from regulatory agencies. So, internal auditing is important before the inspection by the regulatory agencies.

8 Steps to Conduct a Successful NEMT Billing Audit!

When it comes to conducting an internal NEMT billing audit, you get to decide how detailed you want to be. Taking a more thorough approach to auditing usually leads to better and more practical results. It is especially true if it has been a while since you last reviewed your billing procedures. 

Since every NEMT billing company is different, no one checklist fits all. There are some general steps that every company should follow when preparing for a NEMT billing audit.

Below are the steps involved in the process of auditing:

Step 1: Review Contracts and Agreements

The first step in a NEMT billing audit is to review the contracts and agreements between the NEMT billing company and the payer. It includes reviewing the terms and conditions of the agreement to ensure that both parties comply with them. 

The audit team may also check to see if the NEMT provider is adhering to state or federal regulations that may apply to their services.

Step 2: Verification of Services Rendered

The audit team will verify that the services billed by the NEMT provider were rendered to the patient. It includes reviewing the patient’s medical records and other documentation to ensure that the services were medically necessary and that they provide to the patient. The audit team may also check to see if the NEMT provider is following specific protocols or procedures for providing their services.

Step 3: Validation of Eligibility

The audit team will verify that the patient was eligible for the NEMT service. Also,  the NEMT billing service providers have the proper documentation to support eligibility.

This step involves reviewing the patient’s contact information, eligibility criteria, and other relevant information. The purpose is to ensure that deserving patients are getting the services of NEMT.

Sometimes, patients who are not eligible to receive NEMT services are still receiving them. It is the responsibility of NEMT providers to confirm their eligibility. Otherwise, they will face the impact of claim denials or penalties from the audit team.

Step 4: Examination of Claims

In the fourth step, the audit team will examine the claims submitted by the NEMT billing service provider. They will check the claim’s accuracy and completeness. They will also ensure that all the claims comply with the latest medical regulations and guidelines.

The audit team will review the claims for errors, discrepancies, or inconsistencies. The team will also verify the coding used by the billing service provider. The codes used should be correct and appropriate for the service provided.

Step 5: Review of Medical Records

As a NEMT billing audit team, you must review all the medical records. It is your responsibility to ensure that all the records are properly documented. There is enough supporting evidence available to prove the billed claims.

The team must also review the documentation for any missing or incomplete information. You must identify discrepancies, inconsistencies, and potential fraud or abuse inside the company.

Step 6: Identification of Errors

The team will identify any errors or discrepancies during the audit. The team is also responsible for documenting the mistakes. It includes any billing errors, documentation errors, or other issues that may be identified during the audit process.

Step 7: Recommendations for Improvement

Based on the audit findings, the audit team may make recommendations for improvement to the service providers. These recommendations may include changes to their billing processes and improvements to their documentation practices.

It may also recommend changes to ensure compliance with regulations and guidelines. The main purpose of all these recommendations is to improve service quality.

Step 8: Reporting

The audit team will prepare a report summarizing the findings of the audit and any recommendations for improvement. This report will be provided to the appropriate parties, such as the payer or the billing service provider. This report may help inform future audits or guide improvements to the NEMT billing provider’s services.

Final Thoughts

Conducting a NEMT billing audit is crucial for any NEMT billing company. It helps ensure that the company complies with regulations and provides quality services to customers. By following the steps outlined in this blog post, NEMT providers can conduct a successful audit that identifies any potential issues. They can also provide recommendations for improvement.

Don’t wait until an external regulatory agency audits your business to identify potential compliance issues. Conduct an internal audit now to avoid penalties and ensure you provide the best possible service to your patients. So, if you haven’t already, start planning for a successful NEMT billing audit today.

Feel free to contact us if you need any help conducting an audit or have any questions on billing. Our team of experts is always here to help you out.

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