Medical Audit Procedures

Medical audits are performed to ensure patients receive a high quality standard of care. Auditors evaluate medical progress notes and claims to make sure information is accurate, as well as to eliminate the possibility of medical coding fraud.

Notification

Clients are notified of upcoming audits. The notification process gives the entity being audited time to gather requested documents, such as billing notes or encounters, and have it ready for when the auditors come in. For investigative audits, however, auditors do not have to provide advanced notification. They can show up unannounced.

Entrance Meeting

According to Southwestern Medical Center, when auditors arrive to the site they are auditing they meet with medical staff to discuss the scope and purpose of the audit, as well as how long the audit is expected to last.

Review

Auditors may request to review a company's policies and procedures, job descriptions, organizational chart and other business documents that give them background information about an organization. Auditors may ask questions to seek more clarification, so companies should make sure staff are available to answer.

Audit

Auditors perform audits through documentation research, visual observations and interviews. Auditing is the process of gathering information and determining its accuracy, honesty, integrity and functionality. Fraudulent documentation, for example, is dishonest and would not pass an audit.

References

• Southwestern Medical Center: The Audit Process