Medical Auditing Practice Exam

What resource helps in identifying incorrect coding practices during an audit?

1. NCCI edits

2. Internal financial reports

3. Patient testimonials

4. Employee feedback forms

The correct answer is: NCCI edits

NCCI edits, or National Correct Coding Initiative edits, play a crucial role in identifying incorrect coding practices during an audit. These edits are developed by the Centers for Medicare & Medicaid Services (CMS) and are designed to promote correct coding methodologies and prevent inappropriate payment for services that are not medically necessary. By examining the coding against these established edits, auditors can pinpoint discrepancies, such as bundled services that should not be billed separately or protocols that may lead to denials due to improper coding. In contrast, internal financial reports provide a snapshot of the organization's financial performance but do not directly address coding practices or the accuracy of claims submissions. Patient testimonials may offer insights into patient experiences but are not relevant for auditing coding accuracy. Employee feedback forms can help identify potential inefficiencies or areas for improvement within the organization but do not serve as a foundational resource for assessing coding compliance. Thus, NCCI edits stand out as the most appropriate resource for ensuring that coding practices adhere to established standards.