Who should typically be involved in a claim submission audit?

In a claim submission audit, it is crucial to involve individuals with the appropriate expertise and skills to ensure an accurate and thorough evaluation of the claims process. A medically trained person possesses the clinical knowledge needed to assess the medical necessity of services rendered, review documentation accuracy, and ensure compliance with applicable regulations and guidelines. Similarly, the billing supervisor brings a solid understanding of the billing processes, coding practices, and the financial aspects of claim submissions.

Together, these professionals can effectively identify discrepancies, errors, and areas of non-compliance in the submission of claims. Their collaboration enables a comprehensive analysis that covers both medical and administrative perspectives, making the audit process more robust and efficient. This combination of clinical knowledge and billing oversight is critical for maintaining compliance with healthcare regulations and optimizing revenue cycle management, thus enhancing the overall integrity of the claims submission process.