Conducting an Internal Coding Audit: 10 Must Know Tips for the Auditing Team

Why This Topic Matters

Internal coding audits can help practices evaluate coding accuracy, documentation support, and compliance processes. Understanding the main stages of an audit helps organizations prepare staff, organize review materials, and build follow-up processes that support quality improvement.

Article Sections

1. Introduction

   Introduces the purpose of internal coding audits and the operational concerns they address in physician practices and healthcare organizations.

2. Define the scope of your audit

   Discusses how to decide what types of services and review periods to include in an audit.

3. Determine key players

   Covers who may participate in the audit process and the importance of organizational approval and collaboration.

4. Assemble reference materials

   Describes the kinds of manuals, edits, policies, and worksheets that may be gathered for review.

5. Verify the accuracy of billed services

   Explains the use of claim-related documentation and supporting records as part of audit preparation.

6. Include basic coding audit elements

   Outlines broad areas commonly checked during a coding audit, including documentation support, code usage, and related billing factors.

7. Incorporate basic compliance items

   Reviews general compliance topics that may be included alongside coding findings.

8. Prepare a summary of findings

   Addresses organizing audit results into a clear summary or report for internal use and feedback.

9. Schedule physician feedback meetings

   Covers the provider review process and the use of individualized examples to discuss audit results.

10. Prepare written recommendations

    Describes the need for follow-up recommendations and potential corrective actions after the audit.

11. Set up ongoing monitoring

    Explains post-audit follow-up activities such as training, coaching, re-audits, and policy updates.

12. Author information

    Provides background on the article author and professional affiliations.