A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which document?

A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which document?

• A. A billing worksheet from the patient’s account
• B. The patient’s medical record
• C. Insurance contract
• D. Receipts

Answer: (A)

Prospective audits focus on ensuring that what is billed matches what was documented and charged in the internal system. By reviewing the completed claim form against the billing worksheet from the patient’s account, the coder-biller can confirm that the dates of service, procedures or services, codes, units, and patient responsibility on the claim align with the internal record of charges. This cross-check helps catch discrepancies such as services billed that weren’t documented, incorrect codes, or missing charges before submission, which is a key way to prevent fraud. The patient’s medical record contains clinical documentation that supports why services were performed, but it’s not the primary internal billing reference used to verify the accuracy of the bill itself. An insurance contract governs payer rules and reimbursement terms, not the item-by-item matching of charges to billed items. Receipts aren’t the standard source for this cross-check in a prospective billing audit.

Prospective audits focus on ensuring that what is billed matches what was documented and charged in the internal system. By reviewing the completed claim form against the billing worksheet from the patient’s account, the coder-biller can confirm that the dates of service, procedures or services, codes, units, and patient responsibility on the claim align with the internal record of charges. This cross-check helps catch discrepancies such as services billed that weren’t documented, incorrect codes, or missing charges before submission, which is a key way to prevent fraud.

The patient’s medical record contains clinical documentation that supports why services were performed, but it’s not the primary internal billing reference used to verify the accuracy of the bill itself. An insurance contract governs payer rules and reimbursement terms, not the item-by-item matching of charges to billed items. Receipts aren’t the standard source for this cross-check in a prospective billing audit.