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Billing and coding

Audits

QuestionAnswer
A formal examination or methodical review.​ Audit
Before they are processed Prepayment audit
After payment has been made Postpayment audit
The auditor requests the complete medical records of selected plan members for a specified period Private Payer Postpayment Audits-
Is a program designed to audit Medicare claims. ​ The Recovery Audit Contractor (RAC)
Multiple or excessive number of units billed, Obvious “black and white” coding errors, and medically unnecessary treatment RAC looks for the following when performing an audit
Self-audit conducted by a staff member or consultant:​ Internal audit
Internal audit of claims conducted before transmission.​ Prospective audit
Internal audit conducted after claims are processed and RAs have been received and audit of the COB Retrospective audit
Is a document that a customer sends to a supplier to confirm that an invoice has been paid​ ​Remittance advice (RA)
Created by: InstructorWatson
 

 



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