What are external audits in medical billing?

External audits in medical billing refer to a thorough examination of records conducted by an independent entity, such as a private payer or a government investigator. This type of audit is focused on ensuring compliance with relevant regulations, policies, and guidelines. The purpose of these audits is to verify that billing practices are accurate and align with established standards, which helps to identify any discrepancies, potential fraud, or improper billing practices.

In this context, external audits serve as a critical mechanism for oversight within the healthcare system. They can lead to corrective actions if issues are found, thus safeguarding against improper billing and enhancing the integrity of the healthcare billing process.

Other options describe activities that do not qualify as external audits. For example, a self-conducted audit by a staff member pertains to internal checks rather than an independent review. Similarly, audits of old claims after payment has been processed may not align with the purpose of compliance verification as conducted in an external audit. Reviews of billing records for internal performance improvement focus on enhancing internal processes rather than assessing compliance from an external perspective.