Primary Care Billing and Coding Audit Checklist Form
Complete this checklist to assess primary care billing and coding accuracy and compliance. This form collects only non-sensitive information relevant to the audit process.
Auditor Full Name
*
First Name
Last Name
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Provider or Practice Name
*
Patient Encounter Reference (e.g., Encounter ID or Code)
*
Is the documentation for this encounter complete and legible?
*
Yes
No
Partially
Was the coding for the encounter accurate and appropriate?
*
Yes
No
Partially
Were all required billing modifiers present and accurately applied?
*
Yes
No
Not Applicable
Was the claim submission process followed correctly?
*
Yes
No
Partially
Were any follow-up actions or corrections required?
*
Yes
No
Additional Comments or Audit Findings
Submit Audit Checklist
Should be Empty: