As the name implies, medical auditing involves the quantitative analysis of current medical practice and its comparison to the standards of quality. The process includes analyzing the use of resources, the procedures used to diagnose patients, and the quality of life for patients. The Department of Health has modified its definition to reflect "Working for the patient." These professionals are responsible for identifying problems in medical practices and suggesting solutions. For more information on the field, see The Job Description of Medical Auditors
Medical audits may be conducted on a variety of levels. The first level evaluates the coding accuracy and appropriateness of policies and procedures. In addition, medical auditors may also evaluate the overall health of a medical provider and suggest areas that need improvement. This is especially useful for spotting outliers before they become major payers. For instance, outliers may have higher reimbursement rates than their peers due to improper coding, insufficient documentation, or other issues. Additionally, medical audits can identify any gaps or inaccuracies in patient records that could cause a significant reduction in revenue or even a total loss of revenue.
An audit can uncover billing problems and no problems at all. It can also uncover problems that are systematic, random, or both. For example, a medical auditor may discover fraud when doctors bill for procedures that they did not perform. For instance, incorrect billing codes can result from improper staff communication, which can lead to false claims. A medical audit can also save government funds by reducing medical office costs. Its main advantage is that it helps improve the efficiency of a medical office.