What is the primary focus of a retrospective audit?

The primary focus of a retrospective audit is to evaluate the accuracy of submitted claims. This type of audit involves reviewing previously submitted claims to determine whether they were coded, billed, and reimbursed correctly, based on the documentation and coding guidelines that were in effect at the time the services were provided. The goal is to identify any discrepancies or errors that may have occurred during the billing process, which can inform adjustments to billing practices and enhance future claims accuracy.

Reviewing prior billing methods, while relevant, is not the central purpose of a retrospective audit; the focus is on verifying the correctness of what has already been billed. Current coding changes are generally outside the scope of a retrospective audit, which deals with claims that have already been processed. Similarly, providing feedback on clinical staff performance may be a part of a broader quality assurance program but is not the primary aim of a retrospective audit focused on claims and coding validity.