How many medical records does the OIG recommend auditing per federal payer?

The OIG recommends auditing a specific number of medical records per federal payer to ensure compliance and identify potential issues in billing and documentation practices. Auditing five or more records is considered a best practice because it offers a more comprehensive view of the patterns and trends in coding and billing processes.

Using at least five records allows providers to analyze data effectively, facilitating the identification of areas where improvements can be made in documentation or coding compliance. This number strikes a balance between being manageable and providing adequate data for a meaningful audit, enabling healthcare organizations to better detect and address compliance risks that could lead to financial penalties or legal issues.

Opting for a lower number of records may not provide enough information to accurately assess compliance, while a higher threshold could lead to unnecessary burdens and may not yield proportionate insights. Therefore, the recommended practice aligns with the goal of thoroughness in audits while remaining feasible for healthcare providers.