A multi-specialty group reviews E/M levels on selected charts before claims are released to the payer. Which audit-timing concept does this describe?
Select an answer to reveal the explanation.
Short Explanation
Catching E/M issues before the claim flies is a prospective audit—like proofreading before you hit send. Retrospective is the post-payment autopsy; both have a place, but pre-drop review is the early warning system.
Full Explanation
Prospective coding audits review documentation and code selection before claims are submitted, allowing correction of E/M or other errors prior to billing. Retrospective audits occur after submission or payment. Physician practices commonly use prospective reviews for high-risk areas such as E/M leveling as part of an effective compliance program.