tci Medicare Compliance & Reimbursement - 2012 Issue 8
Compliance: Let Audits Help You Capture Missed Charges and Improve Compliance
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Article Overview
This article explains how internal chart audits can help medical practices improve billing accuracy, identify missed charges, and align documentation and coding practices with payer expectations. It compares prospective and retrospective audit approaches, discusses how often audits may be performed, and describes general areas practices may prioritize when building an audit process. The content is aimed at office administrators, billers, coders, and compliance-focused practice staff.
Why This Topic Matters
Regular auditing can help practices spot recurring documentation and billing problems before they lead to denials, repayment demands, or broader compliance concerns. For teams responsible for charge capture and coding integrity, the article offers a practical framework for deciding how to structure an internal audit program.
Article Sections
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Get to Know the Audit Types
Introduces the two broad internal audit approaches and compares their operational characteristics at a high level. The section frames how practices think about audit timing and workflow impact.
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Set a Twice-a-Year Auditing Goal
Discusses general factors that influence how often audits are performed, including practice size, resources, and the need for recurring review. The section emphasizes establishing a practical audit cadence.
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Focus Audit on Commonly Billed Services
Explains how practices may prioritize routine or frequently billed services when planning audits. The section also points readers toward external guidance sources used to identify areas of oversight interest.
What You Will Learn
- How internal chart audits support billing accuracy and compliance
- The difference between prospective and retrospective audit approaches
- Factors that influence audit frequency in different practice settings
- How practices may choose general audit focus areas
- Why external compliance guidance can inform an internal audit plan
Who Should Read This
- Medical practice administrators
- Medical coders
- Medical billers
- Compliance staff
- Physicians and group practice owners
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