Compliance Evaluation: Evaluate Your Billing Procedures With Internal Audits, Before an Outside Auditor Does

Why This Topic Matters

Internal audits can reveal compliance risks and documentation gaps early, helping practices improve billing accuracy and prepare for payer scrutiny. The article is relevant for organizations building a practical audit workflow and deciding how to structure recurring internal reviews.

Article Sections

1. Reap Internal Review Benefits

   Introduces the purpose of internal reviews and the general advantages of evaluating billing and coding processes from within the practice.

2. Start With a Baseline Evaluation

   Describes the role of an initial baseline review and how it informs the timing and focus of future audits.

3. Follow a Checklist

   Outlines the major planning questions used to define an internal review, including scope, chart selection, documentation review, and denial follow-up.

4. What is the focus of the audit?

   Explains the need to define the objective of the review before beginning the audit process.

5. What will the audit's scope be?

   Addresses the general parameters of the review, such as providers, services, date ranges, payers, and broad billing topics.

6. How will you select charts?

   Discusses chart selection methods and the need to review a representative sample of services.

7. What documentation will you review?

   Covers the types of supporting records that may be gathered for an internal review.

8. Why am I finding denials?

   Focuses on reviewing denials during an audit or billing review to understand unresolved claim issues.