What is the main objective of conducting compliance reviews in healthcare billing?

Conducting compliance reviews in healthcare billing primarily aims to ensure accuracy and compliance with applicable regulations. This process involves systematically evaluating billing practices to verify that they adhere to federal and state laws, as well as payer requirements. By focusing on compliance, organizations can detect errors, prevent fraud, and safeguard against potential legal and financial repercussions.

The accuracy of billing is critical not only for maintaining the integrity of revenue cycles but also for upholding patient trust and satisfying regulatory demands. Such reviews help organizations align their billing procedures with standards set forth by entities like the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), and other regulatory bodies.

In contrast, while lowering operational costs, enhancing marketing strategies, or streamlining employee training may be beneficial for healthcare operations, these aspects do not directly relate to the primary purpose of compliance reviews in billing. Therefore, ensuring accuracy and adherence to regulations stands out as the central objective of this important practice.