The Do's and Don'ts of Audit Investigations

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Note:  The following article synopsis was NOT provided by BC Advantage. It was created by Find-A-Code/innoviHealth.

Article Overview

This article discusses general best practices for handling a healthcare audit investigation, with emphasis on preparation, communication, documentation, and working with legal counsel. It is aimed at providers, compliance staff, and billing/coding professionals who may face inquiries from government agencies or payors. The piece covers broad audit-response guidance, internal compliance materials, and cautions about common missteps during an investigation.

Why This Topic Matters

Audit investigations can affect documentation, compliance, and organizational risk. Understanding the broad response process helps healthcare entities organize records, communicate appropriately, and avoid preventable problems during an inquiry.

What You Will Learn

  • How to prepare for a healthcare audit investigation
  • What types of records and internal materials may be relevant during an inquiry
  • General communication practices when contacted by a government agency or payor
  • Common pitfalls to avoid during an audit or investigation
  • Why involving legal counsel early is emphasized in compliance response planning

Who Should Read This

  • Healthcare providers
  • Practice managers
  • Compliance officers
  • Billing and coding professionals
  • Revenue cycle staff
  • Healthcare attorneys

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