What does a successful prospective audit help correct before claim submissions?

A successful prospective audit plays a crucial role in identifying and correcting variances in coding that could lead to denials before claims are submitted. This type of audit examines documentation and coding practices in advance, ensuring that they are accurate and compliant with current regulations and payer requirements. By recognizing discrepancies or incorrect codes early in the process, the audit helps mitigate the risk of claim denials, thus improving the overall revenue cycle for healthcare providers.

This proactive approach streamlines claim submissions, enhances the accuracy of coding, and ensures that services provided are properly documented and billed. As a result, the organization can achieve higher rates of acceptable claims and minimize the administrative burden associated with appeals or rework due to denied claims.