healthcare audit types in cutler bay fl

Top Healthcare Audit Types

There is more than one type of healthcare audit that you must be prepared for. Joyce CPA, LLC in Cutler Bay can inform you about the different healthcare audit types. Knowing which kind of a business audit you need to prepare for allows you to understand what it is that you need to have ready. It is also a way for you to be better informed so that you can seek out the help that you need. At Joyce CPA, LLC, we value keeping our clients well informed. If you are interested in learning more about what makes us different and what we value, contact us at Joyce CPA, LLC today.


Healthcare Audit Types You Can Expect


There are a couple of different healthcare audit types that are fairly common and you should be prepared to understand what it is that they are for.


  • Risk Adjustment & Medical Record Reviews: Typically, these type of audits are conducted by health plans and payers. Their purpose is to ensure that the medical record documentation that is provided validates the claims that are submitted. They also determine if there are other chronic conditions present that may not have been submitted with the claim. If the claim is proven, then Medicare can help to subsidize the claim.


  • Medicare Advantage Risk Adjustment Data Validation: The Centers for Medicare & Medicaid Services may require the health plans to perform one of these audits at any given moment. In these audits, the health plan has only forty-five days to send the Centers for Medicare & Medicaid Services–or CMS–”one best medical record” which substantiates all of the reporting submitted.


  • Health Effectiveness Data & Information Set: This type of business audit is meant to review a subsection of the health plan group and focus on very specific measures. For instance, one type of measure could be diabetes monitoring. The information that is gathered from these reports are then given to the National Committee for Quality Assurance where they can issue a quality report card.


  • Care and Quality Improvement Audits: Much like providers, health plans have particular diseases and populations of patients that are considered to be high-risk targets. The goal of these audits is to make sure to enroll members who fit into those populations into preventative care programs so that they may keep their conditions from progressing.

Do You Need a Business Audit?


If you are looking for a trusted accountant that can help you with your business, look no further than Joyce CPA, LLC. We are experienced in the field of finance and we know how to make sure that your healthcare business is running smoothly and receiving its periodic reviews. You can trust us to help you and treat you with the utmost attention. If you would like to learn more about our services as a business auditor or as an accountant, contact us today.


Contact Us


Joyce CPA, LLC is a certified public accountant that is located in Cutler Bay, Florida. We specialize in a variety of fields that include healthcare business auditing. We know the value that we can provide to our clients and we want to ensure that we bring that value to you and your business. If you are interested in learning more about us and what we do, contact us at Joyce CPA, LLC today.

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