What is a prospective audit primarily designed to do?

A prospective audit is primarily designed to intercept claims before they are reported for compliance. This type of audit takes place before services are billed and claims submitted, focusing on identifying any potential compliance issues, documentation gaps, or coding errors at an early stage. It aims to ensure that the claims that later go to payers meet all regulatory and compliance standards, thus preventing the submission of incorrect claims that could lead to denials, audits, or penalties later on.

By addressing compliance issues proactively during the prospective audit, healthcare organizations can implement corrective actions before they impact financial operations or patient care. This ultimately helps in minimizing risks and ensuring accurate and timely reimbursements.