Choosing the Right Tool: Targeted vs. Random E/M Audits

Why This Topic Matters

As evaluation and management guidance continues to change, organizations need practical ways to focus audit resources without losing sight of overall coding accuracy. The article helps readers understand when targeted review is efficient and when random sampling is needed for a broader view of risk.

Article Sections

1. Targeted Audits Save Time but Have Limits

   This section introduces targeted audit selection and discusses the use of benchmarking data to identify utilization outliers. It also describes a Medicare-based analytics workbook used to compare provider patterns by specialty.

2. Random Audits Can Still Be Useful

   This section explains the role of random sampling in reviewing services that fall within typical utilization patterns. It also discusses how random review can help establish a baseline view of provider performance over time.

3. Conclusion: Choose Your Audit Strategy Wisely

   This section summarizes the complementary use of benchmarking and random sampling in audit planning. It emphasizes selecting the audit method that best matches the compliance question being asked.