What should be reviewed as you prepare to perform an audit?

Preparing for an audit requires a comprehensive understanding of the relevant coding and regulatory frameworks that govern the services being audited. Reviewing CPT coding guidelines, federal regulations, and payer-specific guidelines is crucial because these resources provide the necessary framework for accurately coding and billing health care services.

CPT coding guidelines help ensure that the services provided are coded correctly according to the stipulated codes comprehensively. Similarly, federal guidelines dictate the legal and compliance standards that must be adhered to, which can protect against potential audits or legal issues. Additionally, understanding payer guidelines is essential since different insurers may have specific rules regarding documentation, coding, and billing that can significantly impact reimbursement for services rendered.

By focusing on these foundational elements, the auditor can ensure that the audit's objectives are met, leading to accurate financial and compliance outcomes. This knowledge enables the auditor to identify potential coding errors or discrepancies that could affect payment or compliance.

Other options, while important in the broader context of auditing, are secondary to establishing a solid grounding in coding and regulatory guidelines. Patient history, previous audit findings, and institutional policies are valuable resources, but they build off of the foundational understanding gained from guidelines that directly influence coding accuracy and compliance integrity.