AUDITS: Get To The Bottom Of Audits--And Come Out On Top

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article is a practical overview of audit risk for physicians and coding staff, focusing on evaluation and management claims that may be selected for prepayment review. It describes broad reasons claims may stand out, the kinds of documentation patterns auditors may question, and how carriers’ review approaches can vary. The piece is relevant to practices that want to understand audit triggers and strengthen internal chart review processes.

Why This Topic Matters

Audit selection can affect cash flow, administrative workload, and compliance risk. Understanding the kinds of patterns that attract review helps providers and coders evaluate documentation quality and compare office data against external benchmarks.

Article Sections

  1. Why claims are selected for prepayment review

    Introduces the general reasons a carrier may place evaluation and management claims under review and the role of practice-level patterns in attracting attention.

  2. Watch for 3 red flags

    Summarizes common documentation and billing patterns that may prompt closer audit scrutiny and explains why they can appear inconsistent to reviewers.

  3. Other factors that may affect evaluation and management level

    Discusses broader clinical context that can influence how a visit is characterized and why related patient history may matter in review.

What You Will Learn

  • Why some evaluation and management claims are flagged for review
  • How claim patterns can make a practice appear unusual compared with peers
  • Which documentation habits may raise auditor concerns
  • Why supporting clinical context matters in visit-level assessment
  • How carriers’ prepayment review approaches can differ

Who Should Read This

  • Physicians
  • Medical coders
  • Billers
  • Practice managers
  • Compliance staff
  • Auditors

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