When justifying an allegation of error, what are auditors limited to applying?

Auditors are limited to applying controlling standards when justifying an allegation of error because these standards provide the framework and criteria for assessing compliance and accuracy in medical billing and coding practices. Controlling standards encompass regulations, policies, and criteria established by authoritative bodies that govern the healthcare industry, ensuring that audits are grounded in recognized rules and definitions.

By adhering to controlling standards, auditors can effectively evaluate whether the billed services meet the necessary legal and ethical criteria. This application ensures that the audit process is consistent and defensible, based on established guidelines rather than subjective interpretations or varying opinions.

In contrast, while guidelines from previous audits, expert opinions, and financial impact assessments can provide useful context or supplementary information, they are not the primary mechanisms through which auditors can justify their findings. The reliance on controlling standards ensures that the outcomes of audits are based on objective measures, maintaining integrity and credibility in the auditing process.