BC Advantage - 2022 Issue 1
Should Your 2022 Audit Plan Include Paid Claims?
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Article Overview
This article examines a practical audit-planning question for 2022: whether organizations should include paid claims in audit samples. It is aimed at auditors, compliance professionals, coders, and revenue cycle teams that need to understand how audit scope, claim payment review, and documentation review can intersect. The discussion stays at a high level, covering how organizations may think about retrospective versus prospective audits, service and documentation review, and the relationship between audit processes and payment information.
Why This Topic Matters
Choosing whether to include paid claims can affect what an audit reveals about documentation, billing integrity, and payment outcomes. For organizations that separate coding compliance work from revenue cycle functions, the article highlights why audit scope decisions can influence how complete and useful an internal review will be.
What You Will Learn
- How audit plan design can vary by sample type and review focus
- Why payment status may be considered in an audit sample
- How audit reviews can relate to documentation, billing, and reimbursement information
- How organizations may separate compliance auditing from revenue cycle review
- Why some audit approaches may have broader operational value
Who Should Read This
- Medical auditors
- Compliance professionals
- Medical coders
- Revenue cycle teams
- Health system administrators
- Practice managers
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