Who is qualified to conduct periodic, internal audits?

The qualification to conduct periodic, internal audits primarily hinges on having both the appropriate training and understanding of the coding and billing processes. Coding staff trained in auditing possess the necessary expertise to analyze clinical documentation, coding accuracy, and compliance with regulatory guidelines. Their specific knowledge in coding rules ensures that audits are conducted with attention to detail regarding medical necessity, accurate coding, and billing practices.

Trained coding staff can effectively identify discrepancies and areas for improvement in documentation and coding, which is critical for maintaining compliance and optimizing reimbursement. This structured understanding allows them to assess the completeness of records and ensure that all services provided are appropriately captured in the coding.

In contrast, the other groups mentioned lack the specialized training required to execute such audits effectively. Administrative staff might not possess the detailed knowledge of coding systems, and while upper management personnel often have an understanding of organizational operations, they may not have the technical expertise necessary for a thorough audit. External auditors can conduct valuable independent assessments, but they are generally not involved in regular internal audits that are critical for consistent compliance monitoring and improvement within a practice or facility.

Thus, the choice that specifies coding staff trained in auditing aligns best with the requirements for conducting these internal evaluations effectively.