BC Advantage - 2022 Issue 1

Should Your 2022 Audit Plan Include Paid Claims?

In 2022, when we sit down to configure an audit plan, we often consider whether we will perform an audit retrospectively or prospectively, and whether the sample will include evaluation and management (E&M) services, procedures, or some combination of them both. What we find ourselves not always considering these days is whether the claim has been paid or not. I hadn't thought about this consideration of the audit process in a long time until recently when a NAMAS member emailed me a question. She asked if her organization should insist on using paid claims as their audit sample...

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