What is the primary focus of a retrospective audit?

The primary focus of a retrospective audit is to ensure compliance of services reported previously. This type of audit involves reviewing and evaluating the documentation and coding supporting claims that have already been submitted and paid. By focusing on past claims, the auditor can determine if the services provided were accurately documented, coded, and billed according to the regulations and guidelines in place during the time the services were rendered.

This process helps identify any discrepancies or errors in the claims submitted, which may have implications for compliance with payer policies, coding regulations, and overall legal standards. Through such an audit, the organization can address any past issues, improve their processes, and take corrective actions to avoid future compliance problems.

The other options do not capture the essence of a retrospective audit. For instance, evaluating current claims against pending standards pertains more to a prospective audit, where the focus is on ongoing processes. Analyzing the claims of a specific provider is too narrow for a retrospective audit, which typically assesses a broader range of services or providers depending on the audit’s scope. Lastly, defining the scope is part of the audit planning phase but does not represent the primary focus of a retrospective audit itself.