What is the focus of a limited audit scope?

The focus of a limited audit scope is specifically on reviewing a provider's claims submitted to a single carrier. This type of audit is typically designed to provide detailed insight into the specific billing practices of a particular provider and how those claims are received and processed by a single insurance company.

By narrowing the focus to one provider and one carrier, auditors can perform a more targeted analysis, identifying potential coding inaccuracies, billing errors, or compliance issues that may be unique to that relationship. This concentrated approach allows for a clearer understanding of the provider's coding performance and the carrier's reimbursement patterns, facilitating more effective corrective action if necessary.

In contrast, analyzing coding for all providers would result in a much broader scope that doesn't allow for the same level of detailed insight into specific claims. Similarly, assessing multiple CPT codes for compliance expands the focus beyond the individual provider and their relationship with the carrier, while evaluating claims in a broad geographic area neglects the specificity needed to accurately audit a single provider's claims. All of these alternatives would dilute the effectiveness of the audit, making the targeted analysis of claims to one carrier the most efficient approach in a limited audit scope.