Medical audits are conducted to evaluate the quality of care and services provided. The quality of an outcome is determined by the patient's needs and the service's objectives. The result of a service must meet the expectations of its customer. In this context, a patient's expectations may be different from those of a physician. Generally, a healthcare professional should define a patient's needs based on their diagnosis and other relevant factors.
The quality of a service is defined by a series of anatomical, biochemical, and physiological parameters. The summation of all these variables leads to a good outcome. Quality assessment is one tool used in medical audit. This assessment is subjective, however, because assessors make value judgments and must determine whether to award points based on the results. The best results can be documented objectively. For this reason, it is important for medical auditors to communicate clearly with providers.
Medical audits may be internal or external employees. They may work for an insurance company or a government agency. These professionals are often required to follow strict ethical guidelines and keep all information confidential. As a result, the scope of the audit will vary based on the scope of the audit. For example, a CMS-audit will review patient information. An internal medical audit will focus on a single payer, whereas a government-sponsored audit will look at multiple health insurance companies.