Avoid auditing misconceptions with these 3 reminders

Why This Topic Matters

Audits affect coding accuracy, compliance, workflow, and revenue integrity. Understanding the general framework helps practices evaluate whether the article’s discussion of audit methods, reference materials, and follow-up obligations is relevant to their work.

Article Sections

1. #1: Audits are not one-size-fits-all

   Introduces the idea that audit scope and method vary based on the purpose of the review. It outlines general audit categories and the kinds of factors organizations consider when planning a review.

2. Internal vs. external audits

   Compares audits performed within a practice to those conducted by outside parties. The section discusses broad operational considerations associated with each approach.

3. Prospective vs. retrospective audits

   Describes two general timing approaches used in audit activity. It explains how audits may be positioned relative to claim submission and payment.

4. Focused vs. randomized audits

   Covers the difference between targeted reviews and samples selected across broader claim populations. It also notes general methods used to select claims for review.

5. #2: Learning tools are not for one-and-done use

   Discusses the importance of keeping coding knowledge current and using dependable reference materials. It highlights several broad categories of authoritative sources and compliance-related references.

6. #3: The audit may be finished, but the work isn’t

   Summarizes the concept of post-audit follow-up when issues are identified. It also references general corrective and compliance-related actions that may occur after a review.