Make sure your audit is most relevant to your specialty

Why This Topic Matters

Specialty-focused auditing can help practices target their highest-risk billing areas, improve documentation quality, and better prepare for external review. The article also highlights how audit priorities may differ based on service mix, carrier scrutiny, and the specialty of the providers being reviewed.

Article Sections

1. Specialty-focused audit approach

   Introduces the value of aligning audit methods with the clinical and billing patterns of a practice’s specialty. Discusses how audit scope and reviewer experience can affect internal compliance efforts.

2. Evaluation and management documentation review

   Covers review of documentation for evaluation and management services using established guideline sets. Addresses the importance of consistency in audit approach and consideration of site-of-service differences.

3. Diagnosis coding and medical necessity

   Explains why diagnosis coding review matters for some specialties and how supporting documentation and coverage expectations affect audit outcomes. Includes the role of carrier review and medical necessity considerations.

4. OIG work plan and high-risk services

   Describes using annual oversight resources to identify services that may warrant closer audit attention. Emphasizes prioritizing areas with increased review activity.

5. Documentation-based auditing and auditor support

   Focuses on evaluating claims only against what is documented and on supporting audit findings with evidence. Also discusses expectations for auditor experience and specialty familiarity.

6. Medicare par rates for 2005

   Presents a table of Medicare participation rates by specialty and compares year-over-year figures. Includes source attribution and notes on specialty group composition.