decisionhealth Newsletters, Part B News - 2012 Issue 4 (April)
Prevent revenue leaks, contractor reviews with regular internal audits
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Article Overview
This compliance-focused article explains how practices can structure internal audits for E/M and procedure claims, choose audit types, select claims for review, and use common reference tools during the audit process. It is intended for coders, auditors, compliance staff, and practice managers who want to strengthen billing oversight and reduce exposure to payer review activity. The article also situates internal auditing within broader revenue integrity and documentation monitoring efforts.
Why This Topic Matters
Regular internal audits can help practices identify documentation and coding issues earlier, support compliance planning, and improve readiness for external reviews by payers and contractors.
Article Sections
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Compliance
Introduces the overall compliance and revenue-integrity focus of the article and explains why routine review of claims matters for practices.
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How to pick an auditor
Discusses the characteristics and responsibilities of an in-house auditor and when outside help may be appropriate.
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Determine the right type of audit
Outlines several audit approaches and describes the kinds of claim review each approach is intended to support.
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Select the right claims to audit
Covers ways to choose claims and samples for review, including using practice data, patient subsets, and audit tools.
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Use essential audit tools to check claims
Lists reference materials and resources commonly used to evaluate coding, documentation, edits, and payer guidance during an audit.
What You Will Learn
- How internal audits fit into a practice compliance plan
- Ways to organize and staff an internal audit program
- Common audit approaches used for claim review
- Methods for selecting claims and samples for audit
- Reference tools used to support coding and documentation review
Who Should Read This
- Medical coders
- Compliance officers
- Practice managers
- Billing staff
- Internal auditors
Codes Discussed
Code Ranges Discussed
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