Targets

Chapman (2018) explained that coding audits could be prospective (reviewing pre-billed claims), retrospective (reviewing submitted claims), targeted, random, or full-record analyses. Based on her research, prospective coding audits are carefully timed to avoid negative impacts on a facility’s accounts receivable and also to offer an immediate learning opportunity. On the other hand, retrospective coding audits lead to corrections that cause learning delays and require claims rebilling (Chapman, 2018). Based on Chapman, once a facility determines whether to undertake retrospective or prospective coding audits, the next step entails identifying the auditing goals and the chart type targets for coding audits.  

Brownfield and Didier (2009) explained that coding auditors use audit goals to determine review chart types. Besides, high-risk diagnostic-related groups (DRGs) and case mix index data can also be utilized to identify chart types for review and to direct coding audit undertakings (Brownfield & Didier, 2009).