A Checklist for Auditing Your Audit

In order to thoroughly scrutinize an audit, it’s important to understand who requested the audit, why they requested it, and what will be audited in the first place. These questions will help determine if the audit will be internal or external and if the auditor is a good match for the job. No matter how large or small an auditing project is, what went into the audit can be subject to question. 

Below you’ll find a list of questions that you’ll want to ask the audit requestor or the auditor, before the audit begins. 

Why Is There an Audit?

Knowing why the audit is being performed helps you understand the methodology of the entire process.

• Did a third-party carrier discover a particular provider’s evaluation and management (E/M) services fell outside the bell-curve of his peers in that specialty?  
• Is it a physician request because the provider is concerned about documentation and wants feedback?
• Was it an administrator request as part of a compliance program; or perhaps, to audit one, new provider? 
• Is it for an annual compliance review or is it to investigate a potential risk area in the practice?

Who Is Doing the Audit?

Knowing the auditor’s background can help you to better understand the findings. 

• What is the auditor’s background?
• Does the auditor have more operations or clinical experience?
• Do the auditor’s credentials match the need of the audit?
• What audits have they done in the past?

What Will Be Audited?

By knowing the criteria of the audit you’ll be able to understand whether or not any particular issues need to be addressed. 

• Is this an E/M audit? 
• Is it for specific procedures or for a specialty? 
• Is it for a surgical practice or a family practice? 
• Are they for surgeries taken place away from the office? 
• Will diagnosis codes and documentation of medical necessity be involved?

Being prepared for an audit by knowing who, why, and what, can save both you and your organization time and money. Knowing how to carefully scrutinize an audit can prove to be just as important as the audit itself.

For a more thorough guide on how to effectively scrutinize an audit, download our free eBrief, "How To Audit An Audit", click the button below: