Medical Auditing Practice Exam

What defines a comprehensive audit?

1. A review of all claims submitted within the year

2. Selection of a large number of claims potentially focused on specific procedure and/or diagnosis codes

3. A review of patient satisfaction surveys

4. A comparison of billed amounts to paid amounts

The correct answer is: Selection of a large number of claims potentially focused on specific procedure and/or diagnosis codes

A comprehensive audit is characterized by the selection of a diverse range of claims, particularly those that focus on specific procedure and/or diagnosis codes. This approach enables the auditor to perform an in-depth examination of billing practices and compliance issues related to specific areas of care. By analyzing a larger sample of claims with an emphasis on particular codes, auditors can identify patterns of billing, assess coding accuracy, and evaluate adherence to regulations and payer guidelines. This method is essential for highlighting areas where improvements might be needed in coding and documentation practices. The other options, while relevant to various aspects of auditing, do not encapsulate the essence of what constitutes a comprehensive audit. For instance, a review of all claims within the year might be extensive but lacks the focused analysis that a comprehensive audit entails. Similarly, reviewing patient satisfaction surveys is primarily concerned with quality of care rather than billing or coding accuracy. Lastly, comparing billed amounts to paid amounts, while useful for identifying discrepancies, does not provide the depth of analysis into specific coding and documentation practices that a comprehensive audit aims to achieve.