Nov 11, 2025
Written By Elizabeth Cifers
Maintaining compliance while managing a retina practice can feel like being stuck on a hamster wheel, with constantly changing payer rules, documentation requirements, HIPAA, and other compliance areas. However, there is a way to get off that wheel. That’s where internal audits come into play.
You don’t know what you don’t know. An internal audit isn’t about pointing fingers but identifying risks, creating and implementing corrective actions, and protecting your practice. An internal audit in any compliance area is a structured, proactive review designed to identify vulnerabilities before they become costly problems. In retina, where documentation, coding, and high-cost drugs are daily concerns under scrutiny, regular internal reviews are among the most effective ways to discover what you don’t know and reduce risk.
Making internal auditing part of your culture helps establish a structured framework for reviewing, revising, and refining. Start by performing a risk assessment to define areas of your practice that may warrant review. Sticking with the most obvious area, here are some ideas:
• Have you reviewed or been concerned about:
• Does the practice have high utilization of specific modifiers?
• Does the practice have a high denial rate?
Review the data and choose a sample of claims to examine. Then, document your findings and share them constructively. Remember to stay objective when reviewing the data – it’s not helpful to ignore issues. The findings are educational opportunities to facilitate learning and growth, and a way to demonstrate the effectiveness of the practice compliance program. All corrective actions should focus on physician and staff education, refining the process, and updating the policies. Most importantly, repeat the process regularly through monthly or quarterly reviews to build consistency and reinforce a proactive mindset.
Documentation integrity is increasingly scrutinized. Payer examination of medical records to see if the documentation supports the billed services is increasing. Incomplete, cloned, or vague documentation raises red flags and undermines medical necessity, not just for the visit, but also for future visits. An internal audit ensures that exam notes accurately reflect the encounter, diagnostic test interpretations clearly connect to the treatment plan, and each service level is justifiable. Strong documentation is not just about reimbursement; it also ensures transparency and compliance within the medical record.
A well-designed audit program does more than identify issues. It can also increase team performance since the process often uncovers knowledge gaps among staff. When errors or inconsistencies are found, they become learning opportunities. Training based on audit results helps staff members, from front-desk staff to physicians, understand their roles in compliance and increases accountability throughout the practice.
A well-run retina practice doesn’t wait for an outside auditor to identify issues. Instead, it detects and resolves them internally. Internal audits ensure compliance, strengthen documentation, and protect the revenue already generated. Proactive auditing isn’t just about good compliance; it’s smart business.
If your practice is ready to strengthen compliance and documentation, Elizabeth Cifers Consulting can help. ECC builds retina-specific internal audit programs that uncover risks before payers do. And for practices wanting a truly objective view, we also conduct external audits that deliver an honest, data-driven look at performance and compliance readiness.
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