tci Medicare Compliance & Reimbursement - 2012 Issue 21
Self-Audit Your Way to Successful Claims
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Article Overview
This article explains the purpose of self-audits in a physician practice and outlines broad areas to review when checking billing records, claims, and medical records. It is aimed at coding, billing, and compliance staff who want a general framework for evaluating documentation support, claim integrity, and record completeness before an outside audit occurs.
Why This Topic Matters
Self-audits can help practices identify documentation gaps, coding inconsistencies, and compliance concerns early. That makes the article useful for teams responsible for reducing audit risk and improving claim accuracy.
Article Sections
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Self-audit overview
Introduces the purpose of self-audits and the basic materials reviewed during the process. It frames self-audit work as a way to assess documentation, claims, and medical records.
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Why you audit
Explains the general compliance and quality-control reasons practices conduct internal reviews. It emphasizes identifying issues before they are found by outside reviewers.
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Checklist
Presents a practical set of questions used to evaluate chart completeness, documentation support, and claim consistency. The checklist spans coding, consultation documentation, signatures, legibility, and patient record details.
What You Will Learn
- The role of self-audits in physician practice compliance
- How to think about documentation review during an internal audit
- What broad chart and claim elements are commonly checked in a self-audit
- Why internal review can help surface coding and documentation concerns early
Who Should Read This
- Physician practice managers
- Medical coders
- Medical billing staff
- Compliance staff
- Audit preparation teams
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