Medical Auditing Practice Exam

How will a practice determine which surgeries to audit when reviewing the top surgeries performed in the past year?

1. Consulting with surgeons

2. Running a utilization report

3. Reviewing patient feedback

4. Analyzing insurance claims

The correct answer is: Running a utilization report

A practice will determine which surgeries to audit by running a utilization report. This report provides quantitative data on the surgeries performed within a specific time frame, allowing the practice to identify trends in surgical procedures. By examining the frequency of each type of surgery performed, administrators can pinpoint the most common and possibly the most expensive or resource-intensive surgeries. This data-driven approach ensures that the audit process focuses on areas that have the highest impact on the practice's operations and financial health. While consulting with surgeons might provide insights based on their experiences and perspectives, it doesn’t offer the comprehensive data that a utilization report provides. Similarly, reviewing patient feedback is valuable for assessing patient satisfaction but does not directly indicate which surgeries are most commonly performed or might require further scrutiny. Analyzing insurance claims can also be useful, but it may not give a full picture of the utilization of surgeries specifically within the practice, especially if the claims are not representative of the entire patient population treated. Thus, the utilization report stands out as the most effective method for identifying surgeries that warrant further audit.