What Is Medical Auditing?
Medical auditing is a systematic assessment of performance within a healthcare organization. Almost any element of healthcare can be audited, but most audits look at components of payer reimbursement processes to evaluate compliance with payer guidelines and federal and state regulations. By identifying errors and devising remedial actions to eliminate them, the medical audit serves a vital role in a healthcare organization’s compliance plan.
Medical auditing provide a mechanism to:
- Review quality of care provided to patients
- Educate providers on documentation guidelines
- Determine if organizational policies are current and effective
- Optimize revenue cycle management
- Ensure appropriate revenue is captured
- Defend against federal and payer audits, malpractice litigation, and health plan denials
