1. Documentation Review
✔ Verify patient charts match billed services
✔ Check for missing or incorrect CPT/ICD codes
✔ Confirm signature and date requirements are met
2. Billing Process Evaluation
✔ Match submitted claims with EHR entries
✔ Review claim submission timelines
✔ Ensure modifiers and place-of-service codes are accurate
3. Internal Controls
✔ Validate user roles and access to billing systems
✔ Confirm system logs are tracking edits and updates
✔ Review refund and adjustment procedures
4. Error Tracking & Reporting
✔ Maintain audit logs with identified errors
✔ Generate monthly compliance reports
✔ Flag repeat errors for training or system fixes
5. Corrective Action Plan
| Days to Implement | Action |
| 1–3 Days | Acknowledge issue and assign owner |
| 4–7 Days | Investigate root cause |
| 8–14 Days | Fix error and document resolution |
| 15+ Days | Conduct follow-up audit |
