Which of the following would NOT typically be examined during a retrospective audit?

Which of the following would NOT typically be examined during a retrospective audit?

• A. Claim forms
• B. Staff performance evaluations
• C. Medical record documentation
• D. Explanation of benefits

Answer: (B)

The choice of staff performance evaluations as not typically examined during a retrospective audit is accurate because retrospective audits focus primarily on the review of clinical and billing aspects of patient care already provided. The primary goal of these audits is to ensure that the coding and billing associated with medical services are accurate, reflect the care given, and comply with payer guidelines. Retrospective audits commonly involve reviewing claim forms to assess whether the submitted charges were appropriate for the services rendered. They also include examining medical record documentation to ensure that there is sufficient evidence to support the claims filed, as well as reviewing explanations of benefits to confirm that payments were processed correctly according to the claims submitted. While staff performance evaluations are crucial for assessing the effectiveness of medical personnel and improving practice operations, they are not typically the focus of retrospective audits, which aim to evaluate the clinical and billing practices rather than the performance of staff members. This distinction highlights why staff performance evaluations do not fit into the scope of a retrospective audit.

The choice of staff performance evaluations as not typically examined during a retrospective audit is accurate because retrospective audits focus primarily on the review of clinical and billing aspects of patient care already provided. The primary goal of these audits is to ensure that the coding and billing associated with medical services are accurate, reflect the care given, and comply with payer guidelines.

Retrospective audits commonly involve reviewing claim forms to assess whether the submitted charges were appropriate for the services rendered. They also include examining medical record documentation to ensure that there is sufficient evidence to support the claims filed, as well as reviewing explanations of benefits to confirm that payments were processed correctly according to the claims submitted.

While staff performance evaluations are crucial for assessing the effectiveness of medical personnel and improving practice operations, they are not typically the focus of retrospective audits, which aim to evaluate the clinical and billing practices rather than the performance of staff members. This distinction highlights why staff performance evaluations do not fit into the scope of a retrospective audit.