Ensure Personal Quality An Auditor's Approach to Research

Why This Topic Matters

Coding and auditing guidance can vary by setting and change over time, so knowing where to look is essential for consistent review quality. The article helps readers understand the types of resources commonly used to verify guidance and stay current.

Article Sections

1. Researching unfamiliar specialties

   Introduces the challenge of auditing in areas that may be outside a reviewer’s core expertise and emphasizes staying current in a changing coding environment.

2. Using forums as a starting point

   Describes informal online discussions as a way to identify common questions and recurring coding concerns before moving to official sources.

3. Official resources and payer guidance

   Covers the use of CMS, Medicare contractors, and coding manuals as primary reference points, along with the role of payer guidance in research.

4. MAC-level research and state-specific guidance

   Explains how local Medicare contractor guidance can differ from broader policy and references the process for locating the relevant contractor for a state.

5. CMS research and coding manuals

   Summarizes broader federal research approaches and the kinds of CMS resources and coding references that can support review work.

6. Returning to coding fundamentals

   Highlights the value of chapter guidance, instructional notes, and baseline coding references when reviewing complex or ambiguous cases.

7. Conclusion

   Wraps up the article’s main message about ongoing learning, flexibility, and using multiple research paths to support audit quality.