What typically does a compliance audit involve?

A compliance audit primarily focuses on an analysis of claims data to ensure that the medical practice adheres to relevant laws, regulations, and policy guidelines. The goal is to identify discrepancies in billing practices, verify that services billed were actually provided, and ensure that the coding used for billed services is accurate and compliant with coding guidelines.

This process often involves comparing submitted claims against patient records and supporting documentation to confirm that they align with the services rendered. It may also include evaluating whether these claims comply with payer requirements and government regulations, which helps mitigate risks associated with audits from external entities such as Medicare or private insurers.

While reviewing practice policies, marketing materials, or staff performance can be important for overall practice efficiency and compliance, they do not specifically represent the core focus of a compliance audit. Thus, the thorough analysis of claims data stands out as the fundamental aspect of such an audit, enhancing the practice's ability to avoid potential fines or penalties.