Certified Risk Adjustment Coder (CRC)

Retrospective audits can be performed by which of the following?

1. Only internal employees

2. Only external consultants who have prior experience

3. Both internal employees and external consultants with a signed business agreement

4. Only during the data submission process

The correct answer is: Both internal employees and external consultants with a signed business agreement

The option suggesting that both internal employees and external consultants with a signed business agreement can conduct retrospective audits is accurate because it recognizes the versatility and collaborative nature of audits in a healthcare setting. Retrospective audits are essential for ensuring the accuracy, compliance, and quality of coding and billing processes after the services have been rendered. Both internal employees, who have a deep understanding of the organization’s practices and policies, and external consultants, who bring in fresh perspectives and specialized experience, can effectively assess and improve coding practices. The requirement of a signed business agreement ensures that there are clear expectations, confidentiality, and compliance with regulations when external consultants are involved. This collaboration can enhance the effectiveness of the audit, as it allows for diverse insights and expertise to address potential issues in risk adjustment coding. Other options restrict the auditing capability to a single group, which could limit the effectiveness and thoroughness of the audit process, as it relies solely on a single perspective that might miss critical insights or areas for improvement.