Medical Billing Compliance and Coding Audit Checklist [FREE PDF]

This medical billing compliance and coding audit checklist ensures compliance with OIG Compliance Guidance Medical Practices requirements. Billing Compliance Managers use this checklist to maintain standards, document compliance, and protect the organization from regulatory and operational risk.

Industry: Healthcare / Medical Billing
Frequency: Quarterly
Estimated Time: 2-3 hours
Role: Billing Compliance Manager
Total Items: 20
Compliance: OIG Compliance Guidance Medical Practices, CMS Medicare Billing Requirements, HIPAA 45 CFR 162 Transactions, AMA CPT Coding Guidelines

Pre-Inspection and Documentation Review

Review records, prior findings, and regulatory requirements before beginning.

Required documentation and permits available for review?
Prior inspection findings and corrective actions verified?
Qualified personnel assigned for this inspection?
Required pre-inspection notifications made?

Primary Compliance Checks

Core inspection items for this category.

Compliance with primary regulatory requirements verified?
Operational procedures documented and being followed?
All staff currently trained and certified as required?
Equipment, systems, and facilities in compliant condition?
No active complaints, violations, or outstanding corrective actions?

Secondary and Supporting Requirements

Additional compliance verification items.

Records, logs, and reports current and complete?
Emergency procedures current and staff trained?
Preventive maintenance schedule current for all equipment?
Third-party certifications, audits, or inspections current?

Findings and Corrective Actions

Document findings and establish corrective action plans.

Any deficiencies, non-conformances, or violations found?
Corrective actions assigned with due dates and owners?
Photo documentation captured?
Inspection summary and recommendations

Inspection Closeout

Complete inspection record and schedule follow-up.

All checklist items completed?
Supervisor review and sign-off obtained?
Next inspection date confirmed?

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Why Use This Medical Billing Compliance and Coding Audit Checklist [FREE PDF]?

This medical billing compliance and coding audit checklist [free pdf] helps healthcare / medical billing teams maintain compliance and operational excellence. Designed for billing compliance manager professionals, this checklist covers 20 critical inspection points across 5 sections. Recommended frequency: quarterly.

Ensures compliance with OIG Compliance Guidance Medical Practices, CMS Medicare Billing Requirements, HIPAA 45 CFR 162 Transactions, AMA CPT Coding Guidelines. Regulatory-aligned for audit readiness and inspection documentation.

Frequently Asked Questions

What does the Medical Billing Compliance and Coding Audit Checklist [FREE PDF] cover?

This checklist covers 20 inspection items across 5 sections: Pre-Inspection and Documentation Review, Primary Compliance Checks, Secondary and Supporting Requirements, Findings and Corrective Actions, Inspection Closeout. It is designed for healthcare / medical billing operations and compliance.

How often should this checklist be completed?

This checklist should be completed quarterly. Each completion takes approximately 2-3 hours.

Who should use this Medical Billing Compliance and Coding Audit Checklist [FREE PDF]?

This checklist is designed for Billing Compliance Manager professionals in the healthcare / medical billing industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.

Can I download this checklist as a PDF?

Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.