What is the purpose of an internal audit in revenue integrity?

The purpose of an internal audit in revenue integrity is fundamentally to assess compliance with billing practices. This involves reviewing the processes and systems in place to ensure that all billing is accurate, complete, and adheres to relevant laws and regulations. Such audits are critical in identifying discrepancies, ensuring that charges for services are appropriately captured, and that claims submitted to payers are justified and compliant with both internal policies and external regulatory standards.

This compliance assessment helps organizations minimize risk, reduce the likelihood of audits from external entities, and protect revenue streams. It is an integral part of revenue integrity as it ensures that the organization is not only collecting the revenue it is entitled to but also doing so in a manner that aligns with established guidelines, thus maintaining the integrity of the revenue cycle. This focus is crucial in healthcare settings, where billing and coding accuracy directly impact financial viability and adherence to legal health compliance standards.