A. Medical Bill Audit

- Review IPD and OPD bills before final submission or discharge.
- Verify billed investigations, procedures, surgeries, medications, consumables, implants, and other clinical services against medical records.
- Ensure that billed services are supported by valid clinical documentation and doctors orders.
- Identify duplicate billing, unbilled services, incorrect quantities, and discrepancies between services provided and services charged.
- Verify compliance with approved hospital tariffs and billing protocols.

B. Clinical Documentation Verification

- Cross-check bills against patient case sheets, treatment charts, investigation reports, medication records, procedure notes, and discharge summaries.
- Verify the medical justification for high-value investigations, procedures, and extended hospital stays.
- Identify missing documentation, incomplete orders, and discrepancies requiring clarification from treating doctors or clinical departments.

C. Insurance and TPA Billing Audit

- Review bills for cashless and reimbursement cases.
- Verify billing as per applicable insurance, TPA, and corporate payer guidelines.
- Identify non-payable items, package deviations,



and potential deductions before submission.
- Coordinate with the Insurance and TPA team to resolve queries, deductions, and rejected claims.
- Support accurate and timely preparation of final bills and claim documents.

D. Package and Tariff Compliance

- Audit package-based cases to ensure services are billed according to approved package inclusions and exclusions.
- Identify inappropriate additional charges or missed billable services.
- Verify room category, qualified fees, procedure charges, and other applicable billing components.
- Ensure compliance with approved discounts and authorization processes.

E. Coordination and Reporting

- Coordinate with Billing, Medical Records, Pharmacy, Nursing, Clinical Departments, and Insurance teams to resolve discrepancies.
- Escalate significant billing errors, compliance risks, and recurring gaps to the reporting manager.
- Prepare daily or periodic reports on audit observations, billing corrections, deductions, and recoveries.
- Recommend process improvements to minimize revenue leakage and prevent billing errors.

📌 Billing Auditor (Medical) (Sahibzada Ajit Singh Nagar)
🏢 Livasa Hospitals
📍 Sahibzada Ajit Singh Nagar