Certified Documentation Expert Outpatient (CDEO) 2025 – 400 Free Practice Questions to Pass the Exam

The goal of examining claims data in a chart audit is primarily focused on ensuring compliance and verifying that coding is accurate. This process involves a thorough review of documentation to ascertain that the services billed align with the clinical information provided in patients' medical records. By confirming that the codes used reflect the provided services and diagnoses accurately, healthcare providers can uphold adherence to payer guidelines, prevent claim denials, and maintain compliance with industry regulations.

In this context, compliance refers to adherence to coding standards set by organizations such as the Centers for Medicare & Medicaid Services (CMS) and the American Health Information Management Association (AHIMA). Correct coding is vital not only for accurate billing but also for maintaining the integrity of health data and reporting.

While identifying fraud and abuse, ensuring service authorization, and analyzing patient demographics are important daily practices within healthcare operations, these tasks are not the central aim of a chart audit focused on claims data. Instead, they serve different purposes within overall operational and compliance frameworks. Therefore, the most pertinent focus of a chart audit specifically targeting claims data is on compliance and correct coding.