ED Coding & Reimbursement Alert - 2022 Issue 2
Audits: Know Your Audit Targets Ahead of Time to Improve Results
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Article Overview
This article explains how to plan the scope of an internal or external audit so a practice can focus on the right records and questions before review begins. It is aimed at coders, auditors, compliance staff, and practice leaders working with Medicare-related audits, and it highlights general guidance on audit preparation, documentation access, stakeholder alignment, and coverage resources such as MAC LCDs and CMS materials.
Why This Topic Matters
Well-defined audit scope helps practices use time and resources efficiently, support compliance efforts, and reduce confusion about what records, services, and dates belong in review. The topic is especially relevant for organizations managing Medicare billing, internal monitoring, or externally supported audits.
What You Will Learn
- How audit scope shapes the direction of a review
- Why Medicare coverage resources may matter in audit planning
- How record access and audit participation affect preparation
- Why identifying the audit request source helps define the review
- How to think about the universe of records or claims included in an audit
Who Should Read This
- Medical coders
- Compliance officers
- Practice managers
- Auditors
- Billing staff
- Physicians and provider administrators
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