Outpatient Facility Coding Alert - 2021 Issue 24
Audits: Determine Audit Focus Area to Improve Results
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Article Overview
This article discusses how to plan the focus of an internal or external audit in a medical practice, with emphasis on defining scope, identifying who requested the review, understanding the records and systems involved, and considering payer, documentation, and policy factors. It is aimed at coding, compliance, billing, and audit professionals who need a clearer framework for organizing audits and improving efficiency without exposing unnecessary detail.
Why This Topic Matters
Choosing the right audit scope can save time, reduce cost, and help a practice concentrate on the areas most likely to affect compliance and reimbursement.
Article Sections
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Scope Helps Establish Your ‘Why’ and ‘How’
Introduces the role of audit scope and why it is central to organizing a focused review. It also touches on internal versus external audit considerations and the broader compliance context.
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Ask These Questions
Covers the planning questions used to shape an audit, including the intended goal, access to records, and logistical issues that affect the review process.
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Find the Originator
Discusses the importance of identifying who requested the audit and how that information helps define the audit’s direction, boundaries, and reporting approach.
What You Will Learn
- How audit scope influences the structure and efficiency of a review
- What planning questions help clarify the purpose and logistics of an audit
- Why identifying the requestor and participants matters in audit planning
- How audit boundaries can support clearer reporting and accountability
Who Should Read This
- Medical coders
- Compliance professionals
- Billing staff
- Audit specialists
- Practice administrators
Codes Discussed
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