AUDITS: Uncover The Top Trouble Spots Lurking In Your Charts

Why This Topic Matters

Targeted audits can reveal patterns that may affect reimbursement and compliance across frequently billed services. The article helps readers understand which broad claim areas are commonly reviewed and why they are often prioritized for internal monitoring.

Article Sections

1. Audit focus areas

   Introduces the types of billing and compliance areas that are commonly prioritized for internal review. It also frames audit selection around payer interest, oversight targets, and practice billing patterns.

2. Evaluation and management billing patterns

   Covers office visit coding patterns that may stand out in a review, including higher-level services and mixed coding habits. The section discusses how internal audits can reveal underdocumentation or potential outlier patterns.

3. Modifier use

   Summarizes the article's discussion of modifier-related claim review, with attention to two commonly scrutinized modifiers in office-based billing. It emphasizes that these claim areas are frequent audit subjects.

4. Consultation coding

   Addresses consultation services as another area that payors and auditors monitor closely. The section places consult coding in the context of relative value and comparison with other office visit categories.