What is the primary goal of internal auditing programs for billing and coding?

The primary goal of internal auditing programs for billing and coding focuses on protecting providers from sanctions or fines. This is crucial because accurate billing and coding practices are essential for compliance with various regulations, including those established by federal and state laws. Internal audits help identify any discrepancies, areas of non-compliance, or potential fraud, thereby mitigating the risk of financial penalties that can arise from improper billing practices.

By regularly reviewing billing and coding processes, organizations can ensure that they adhere to industry standards and guidelines, ultimately safeguarding against regulatory actions that could lead to fines or sanctions. This proactive approach not only helps maintain the integrity of the healthcare organization's financial operations but also contributes to the overall sustainability of the organization by avoiding costly legal repercussions.

While increasing revenues, improving patient care, and limiting unnecessary changes to the chargemaster are all important aspects of healthcare operations, they are secondary to the primary goal of compliance. Compliance serves as the foundation upon which effective financial practices, quality patient care, and operational efficiency can be built.