Which of these is NOT considered a common trigger for a compliance audit?

The concept of compliance audits in healthcare aims to ensure that organizations are adhering to regulations, quality standards, and billing practices. Among the common triggers for compliance audits, billing spikes, high Comprehensive Error Rate Testing (CERT) scores, and medical necessity documentation issues are all indicators that may suggest underlying problems or inconsistencies that warrant further examination.

Timely filing of claims, on the other hand, typically does not serve as a compliance audit trigger. This practice is often governed by specific rules and timelines set by payers and regulatory bodies, and an organization’s adherence to timely filing requirements is generally a standard operational procedure rather than an indicator of compliance risk. In fact, timely filing is usually seen positively, as it reflects good operational practices and can contribute to efficient revenue cycle management. Therefore, it is not typically a red flag that would prompt a compliance audit.

In summary, the correct identification of timely filing of claims as not being a common trigger for compliance audits reflects an understanding of how various factors influence audit decisions, highlighting the focus on issues that suggest potential non-compliance rather than routine operational practices.