During which type of audit are variances found after claims submission?

The correct answer is the type of audit that examines claims after they have been submitted, which is known as a retrospective audit. This type of audit is conducted after the services have been rendered and the claims have been paid, allowing auditors to review the documentation and coding used to determine if they were accurate and compliant with regulations.

In retrospective audits, variances or discrepancies can be identified because the audit examines historical data, which may reveal patterns of incorrect coding or billing practices that occurred after the claims were filed. This can help organizations to identify potential overpayments or underpayments, as well as opportunities for improving documentation practices for future claims submissions.

This contrasts with other types of audits, such as prospective audits, which take place before services are provided and focus on documentation and coding accuracy before claims submission to prevent future variances. A focused audit is usually a targeted review pertaining to a specific area of concern, while an external audit involves an independent review of the organization’s financial and operational practices, often with a broader scope than just claims.