Which practice should be used to detect and prevent improper billing practices in a clinic?

• A. Public relations
• B. Internal monitoring and auditing
• C. Scheduling optimization
• D. Inventory management

Answer: (B)

Internal monitoring and auditing is the practice that keeps billing honest by creating ongoing checks on codes, documentation, and payer rules. Regularly reviewing a sample of billed claims against patient records helps verify that the codes and modifiers billed reflect the actual services and meet payer requirements. This proactive approach can catch upcoding, unbundling, miscoding, or fraudulent activity before claims are paid, and it supports corrective actions like staff training, updated policies, and process improvements. Public relations focuses on image, scheduling optimization targets patient flow, and inventory management deals with supplies—none directly ensure billing integrity.