Auditing Medical Records

Investigations for inaccurate and inappropriate claim filing have increased in recent years.  Federal agencies received additional funding and staffing to conduct investigations.

In 2000, the Office of Inspector General (OIG) published Compliance Program Guidance for Individual and Small Group Physician Practices.  Although not mandatory, OIG strongly recommends periodic reviews of your billing practices to monitor your compliance with statutes and regulations associated with claims for reimbursement.

This FAQ addresses the following:

  1. Why should we consider auditing our medical records?
  2. What is the difference between a prospective audit and a retrospective audit?
  3. Who should be our auditor?
  4. How many charts should we audit?
  5. How do we select the sample of charts for review?
  6. What resources are required to perform an audit?
  7. What is the objective of a chart audit?
  8. What types of findings should we expect?
  9. What are examples of underbilling?
  10. What are examples of overbilling?
  11. How are the results best recorded and reported?
  12. What do we do after the audit is completed?

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