When is a retrospective audit performed?

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A retrospective audit is performed after a claim has been submitted and the remittance advice has been received. This type of audit involves reviewing claims and medical records post-payment to ensure that the services billed were necessary, properly documented, and correctly coded according to the guidelines and payer policies. The purpose of this audit is to identify discrepancies or improper billing practices that may need to be addressed to avoid future issues and ensure compliance.

Conducting the audit at this stage allows for a thorough examination of the claim's outcome and ensures that the practice is accurately capturing revenue while upholding standards for quality care and billing integrity. This review can lead to necessary adjustments or further training for billing staff if trends or errors are identified.

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