Medical Auditing Practice Exam

When conducting a medical audit, what is a primary focus?

1. Patient demographics

2. Claim payment histories

3. Correct documentation and coding of procedures

4. Staff training sessions

The correct answer is: Correct documentation and coding of procedures

The primary focus when conducting a medical audit is correct documentation and coding of procedures. This is crucial because accurate documentation ensures that medical records reflect the services provided, which is essential for legal compliance, quality of care, and effective billing practices. Proper coding is necessary to align with billing regulations and reimbursement criteria set by insurers, including Medicare and Medicaid. Auditors assess whether the documentation supports the codes submitted for reimbursement; discrepancies can lead to claim denials or, in severe cases, allegations of fraud. Therefore, maintaining accuracy in documentation and coding is vital for both the financial health of the healthcare provider and the integrity of patient care.