Get CFHP OB/GYN Specialty Medical Record Audit Tool 2011-2024

Medical auditing, like all audits, is the process of examining and reviewing documents and records to ensure accuracy. Medical auditing takes it a step further and examines medical records to ensure that doctors and medical facilities are in compliance with the rules and regulations of the medical field.

There are two main types of healthcare audits that providers face: internal and external. External audits can be broken down further into government and commercial insurance audits.

Your Medical Record Audit Checklist Do the patient records have an accurate patient ID? Do they contain biographical and/or personal data? Is the person(s) providing care identified on each chart entry? Are all entries dated? Are all entries legible? Is the problem list complete?

There are several reasons to perform medical audits. Auditing can help protect against fraudulent claims and billing activity, identify problems before challenged with inappropriate coding, identify opportunity for reimbursement, and recognize the use of incorrect codes, just to name a few.

Determine outliers and focus first in this area. Protect against fraudulent claims and billing activity. Reveal whether there is variation from national averages. Identify and correct problem areas before insurance or government payers challenge inappropriate coding.

Medical auditing is a systematic performance assessment within a healthcare organization. Most healthcare elements can be audited, but many audits look at components of payer reimbursement processes to evaluate compliance with payer guidelines and federal and state regulations.

Such audits can help to: Determine outliers and focus first in this area. Protect against fraudulent claims and billing activity. Reveal whether there is variation from national averages. Identify and correct problem areas before insurance or government payers challenge inappropriate coding.