How will a More Focused Risk-Based Auditing Ensure Full-Scale Claim Variations in the Review When a More Open General Audit did Not?
The risk areas identified for review in the remainder of 2021 include codes for surgical cases, office and bedside procedures, diagnostic tests, drugs, E&Ms, modifiers, and/or situations such as telehealth, teaching physician, or known process changes. The audit sample selection will primarily target the specific risk area to be reviewed and the providers involved in that sample will be captured because they used codes or are confirmed to be involved in a particular billing situation. Routine audits targeted a provider at a particular point in time and therefore collected a more random sample based on what that provider happened to be submitting on a given day or week.