Which statement correctly describes a prospective audit?

Which statement correctly describes a prospective audit?

• A. It focuses only on historical payments.
• B. It evaluates provider performance relative to coding accuracy after submission.
• C. It analyzes billing data retrospectively for error rates.
• D. It intercepts claims coded prior to reporting to ensure coding is compliant with binding carrier standards.

Answer: (D)

Prospective audits are pre-submission checks of coding before the claim is sent to the payer. They intercept claims coded prior to reporting to ensure the codes used are appropriate and supported by documentation, in line with binding carrier standards. By catching issues before submission, they prevent noncompliant codes from being billed and reduce the risk of denials or audit findings later. The other descriptions describe retrospective, post-submission reviews—looking at historical payments or evaluating performance after submission. Those approaches occur after the claim has been submitted or paid, not before. So the statement about intercepting claims coded prior to reporting to ensure coding aligns with carrier standards best captures a prospective audit.

Prospective audits are pre-submission checks of coding before the claim is sent to the payer. They intercept claims coded prior to reporting to ensure the codes used are appropriate and supported by documentation, in line with binding carrier standards. By catching issues before submission, they prevent noncompliant codes from being billed and reduce the risk of denials or audit findings later. The other descriptions describe retrospective, post-submission reviews—looking at historical payments or evaluating performance after submission. Those approaches occur after the claim has been submitted or paid, not before. So the statement about intercepting claims coded prior to reporting to ensure coding aligns with carrier standards best captures a prospective audit.