Which audit type focuses on past claims after remittance advice has been received?

The focused aspect of a retrospective audit is its emphasis on claims that have already been processed and paid, specifically after the remittance advice has been issued. This type of audit examines past claims data to evaluate the accuracy of the billing, coding, and documentation associated with those claims. It helps identify patterns of errors or potential areas for improvement in the coding practices and compliance with payer guidelines.

In a retrospective audit, auditors delve into previously submitted claims to determine compliance with established protocols and regulations. This often allows organizations to uncover discrepancies or issues that, if left unchecked, could lead to regulatory penalties or lost revenue. The results can inform future practices and help refine the processes to enhance overall claim accuracy.

Other audit types, such as internal audits, focus on verifying internal processes and controls, while pre-payment audits evaluate claims before they are processed for payment. External audits generally assess compliance and operational effectiveness from an outside perspective, but they may not specifically aim at claims post-remittance advice. Thus, the retrospective audit stands out for its specific focus on the analysis of claims after they have been settled.