Concurrent hospital auditing: what it is and how to do it

Denials generated during the hospital stay have a feature that makes them especially costly: by the time they are identified, the moment for correction has passed. The procedure was performed, the material was used, the patient was discharged, and the claim reached the payer with an inconsistency that could have been avoided.

Concurrent hospital auditing exists to step in before that point. By working during the hospital stay, it turns auditing from a reactive function into an active prevention mechanism, identifying discrepancies while they can still be corrected at no financial or operational cost to the hospital.

With the accepted denial rate reaching 1.96% of gross revenue in 2024, according to the Anahp Observatory 2025, hospitals that still rely exclusively on retrospective auditing pile up losses that could be avoided before the claim is closed.

What concurrent hospital auditing is

Concurrent hospital auditing is the type of audit that takes place during the patient’s hospital stay, before discharge. The auditor follows the case in real time, reviews clinical records as they are produced and checks whether the procedures, materials and drugs used are documented correctly and in compliance with the payer’s contract rules.

The term “concurrent” means exactly that: the audit takes place alongside care. Each day of the hospital stay is an active checkpoint, and any inconsistency identified can still be corrected before the claim is closed.

The work is done by nurse auditors and physician auditors with access to the medical record and prescription records. The nurse auditor focuses on the compliance of nursing records, the materials and drugs entered and the consistency between what was prescribed and what was billed. The physician auditor reviews the clinical appropriateness of procedures, the match between diagnosis and treatment and the suitability of high-cost items, such as OPME (implants and special materials) and chemotherapy drugs.

Concurrent auditing is carried out both by the hospital, through its internal team, and by the health plan, which may assign auditors to follow higher-complexity or higher-cost hospital stays. The two processes coexist and have different purposes: the hospital protects its revenue; the payer checks that what is being consumed matches what was authorized.

How concurrent auditing works in practice

Concurrent auditing follows the patient’s hospital stay in sequential stages, each with a defined focus and responsibility. What sets this type apart from the others is the ability to intervene while events are still unfolding.

Admission and opening the claim

The process starts at admission. The auditor checks whether the patient’s registration data is correct, whether eligibility with the payer has been confirmed and whether prior authorization for the hospital stay was obtained in line with contract requirements.

Errors at this stage, such as an incorrect membership card number or unverified coverage, compromise the entire claim before the first procedure is even performed.

Monitoring during the hospital stay

With the claim open, the auditor follows the case’s progress daily, checking nursing records, medical prescriptions, the materials and drugs entered and the consistency between the medical record and the items being charged.

This monitoring makes it possible to detect duplicate entries, items without clinical support and discrepancies between what was prescribed and what was billed before they pile up over the hospital stay.

Review of materials, drugs and procedures

High-cost items get priority attention: OPME, restricted-use drugs, chemotherapy drugs and high-complexity surgical procedures.

The auditor checks whether each item has the payer’s authorization, whether the TUSS code used matches the procedure performed and whether the quantity entered is consistent with the clinical condition documented in the medical record. For a deeper look at the main points of attention in this review, see: Hospital claims auditing: 10 points of attention.

Reporting discrepancies and correcting them in real time

Inconsistencies identified during the hospital stay are reported immediately to the teams responsible, whether billing, nursing or the medical team.

The correction happens before the claim is closed, eliminating the risk of denials for technical or documentation issues. This cycle of real-time identification and correction is the main advantage of concurrent auditing over the other types.

Concurrent auditing vs. retrospective auditing

Both types are part of the same hospital audit cycle, but they work at different moments and with very different abilities to intervene. The table below summarizes the main points of comparison:

The two types are complementary. Concurrent auditing prevents the denials that arise during the hospital stay; retrospective auditing catches the inconsistencies that escaped concurrent review and can still be corrected before the claim is sent.

When to apply concurrent auditing

Concurrent auditing delivers the most return in hospitals with certain care and operational characteristics. Knowing these scenarios helps managers prioritize implementation and size the audit team appropriately.

The care profile where it is most indicated

Hospitals with a high volume of long hospital stays, high-complexity surgeries, oncology and frequent use of OPME benefit most from concurrent auditing.

In these cases, each day of the hospital stay means new entries, new prescriptions and new chances of inconsistency. The higher the average cost of the stay, the greater the financial impact of a discrepancy not identified before discharge.

Oncology services deserve special attention. Chemotherapy protocols involve high-cost drugs, treatment cycles with prior authorization for each cycle and complex contract rules that vary by payer.

Concurrent auditing makes it possible to check, at each cycle, whether the items used are authorized, correctly coded and backed by documented clinical support.

Indicators that signal the need for implementation

Some operational signs indicate that the hospital is exposed to losses that concurrent auditing could prevent. A denial rate above 2% of gross revenue, a significant volume of denials for unauthorized or uncovered items, a high rate of adjustments in retrospective auditing and claims reaching billing with incomplete clinical records are clear signs that the process needs a checkpoint closer to care.

A lack of structured communication between the care team and the billing department also indicates a need for concurrent auditing. When the auditor follows the hospital stay in real time, they act as a link between the two areas, anticipating problems that, without that bridge, would only be discovered in the retrospective review.

When partial implementation already delivers results

Hospitals that do not yet have the structure for full concurrent auditing can start with selective coverage: focusing on the highest-cost hospital stays, surgical cases using OPME and patients with an expected length of stay above a certain threshold.

This approach concentrates effort where the financial return is greatest and makes it possible to build the process gradually, without overloading the audit team.

What the regulations say

Concurrent hospital auditing has specific regulatory backing in private healthcare. Knowing these regulations protects the hospital during the process and clearly defines what each party can demand.

Concurrent auditing and the revenue cycle

Concurrent auditing is the most efficient checkpoint in the hospital revenue cycle because it acts before the loss. Each denial prevented during the hospital stay is revenue that will not need to be recovered through an appeal, a claim that will reach the payer cleaner and a financial cycle that closes with less friction.

The impact goes beyond reducing denials. Hospitals with structured concurrent auditing produce more complete medical records, more consistent documentation and claims with a higher first-submission approval rate. This reduces the average time to payment, which reached 68.56 days in 2024 according to the Anahp Observatory, and improves cash flow predictability.

Technology has expanded the reach of concurrent auditing. Platforms that automatically cross-check medical record data against prescriptions, entered items and each payer’s contract rules allow the auditor to identify inconsistencies without relying exclusively on manual checks. The result is broader coverage, with more traceability and less dependence on the number of auditors available.

Hospitals that combine concurrent auditing, technology and well-defined processes build an operation in which revenue protection starts on the first day of the hospital stay, and the financial cycle closes consistently.

FAQ: frequently asked questions about concurrent hospital auditing

What is the difference between concurrent and retrospective audits?

Concurrent auditing takes place during the hospital stay, before discharge, and makes it possible to correct discrepancies in real time. Retrospective auditing is done after discharge, on the closed claim, before it is sent to the payer. The two types are complementary: concurrent auditing prevents; retrospective auditing catches what escaped concurrent review.

Is concurrent auditing mandatory for hospitals?

No specific regulation makes it mandatory for the hospital as a provider. Implementing internal concurrent auditing is a strategic decision and is recommended as a best practice in revenue cycle management.

Who can perform concurrent auditing at the hospital?

Internal concurrent auditing is carried out by qualified nurse auditors and physician auditors, with complementary roles. The Federal Nursing Council and the Federal Council of Medicine define the specific competencies of each profession. The two profiles work together to cover the claim comprehensively.

How does concurrent auditing reduce denials?

Concurrent auditing reduces denials by mapping, while the patient is still in the hospital, inconsistencies between what was performed and what is being billed. Duplicate entries, unauthorized items, incorrect TUSS codes and incomplete clinical records are corrected before the claim is closed, eliminating the main causes of technical and documentation denials.

In which specialties does concurrent auditing have the greatest impact?

The return is greatest in oncology, high-complexity surgeries and hospital stays involving OPME. These are specialties with a high average claim, complex contract rules and a larger volume of items subject to denial. In these cases, each day of the hospital stay without active auditing means concrete financial exposure for the hospital.