What are the three types of MIC audits?

What are the three types of MIC audits?

• A. Focused desk review; Focused field audit; Comprehensive audit
• B. Desk audit; Field audit; Policy audit
• C. Prepayment review; Postpayment review; Reconciliation audit
• D. On-site review; Remote review; Hybrid review

Answer: (A)

MIC audits typically come in three forms to cover different depths of review. A focused desk review is done remotely and looks at a limited set of claims and supporting documents to check for specific issues without visiting the site. A focused field audit moves on-site to the provider’s location and digs deeper into actual workflows, charts, and processes, often including interviews to confirm how billing and documentation are handled in practice. A comprehensive audit is the broadest type, examining a wide range of records and systems—medical records, coding, billing processes, internal controls, and policies—to assess overall compliance. This three-tier approach makes sense because it starts with a lighter, targeted check and escalates to more intensive reviews only as needed, ending with a full-scale assessment when broader risks are identified. Other options mix modalities or focuses (like policy work, pre/postpayment concepts, or remote vs on-site as a separate category) that don’t align with the standard three-tier MIC audit framework.

MIC audits typically come in three forms to cover different depths of review. A focused desk review is done remotely and looks at a limited set of claims and supporting documents to check for specific issues without visiting the site. A focused field audit moves on-site to the provider’s location and digs deeper into actual workflows, charts, and processes, often including interviews to confirm how billing and documentation are handled in practice. A comprehensive audit is the broadest type, examining a wide range of records and systems—medical records, coding, billing processes, internal controls, and policies—to assess overall compliance.

This three-tier approach makes sense because it starts with a lighter, targeted check and escalates to more intensive reviews only as needed, ending with a full-scale assessment when broader risks are identified. Other options mix modalities or focuses (like policy work, pre/postpayment concepts, or remote vs on-site as a separate category) that don’t align with the standard three-tier MIC audit framework.