There are many types of audits. Some are relativity benign, while others bring about a fair amount of anxiety. In either case, knowing how to navigate the process helps to not only alleviate anxiety, but to also ensure the best possible outcome.   The first step in an audit process is to be able to identify the type of audit. Look at the letterhead and determine if the request for records is from an insurance carrier, Medicare, or a third party contracted by an insurance carrier. For example, an insurer may request records as part of a HEDIS (Health Effectiveness Data and Information Set) review. The goal of a HEDIS review is to measure performance on various elements of healthcare services. The letter will generally state this as the reason for the review. These types of reviews are conducted by approximately 90% of health plans and do not result in an overpayment demand. On the other hand, a request for records from CMS Safeguard Services, or from a ZPIC (Zone Program Integrity Contractor) may have you reaching for the phone to call your healthcare attorney. These audits are focused on documentation, coding, and billing, and usually end up with overpayment demands, extrapolations, and in some cases, prepayment reviews. The focus of a ZPIC audit is to identify fraud and abuse. ZPICs have the authority to turn the case over to the Department of Justice (DOJ) or the Office of Inspector General (OIG). Regardless of the type of audit, the key to achieving a successful outcome is dependent upon how you respond.   The first step is to prepare complete records by making four sets of copies, one for each of the following: your office, the insurance carrier, your healthcare attorney, and your coder. It is extremely important to keep copies of what was sent in. Your he…