MFMD guide · AHCA clinic governance

How often must an AHCA Medical Director review billing?

The right answer depends on the facility’s actual structure, regulatory status, services, payer model, and licensed team. This guide organizes the facts that should be resolved before a decision is made.

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Direct answer

Current AHCA survey enforcement states that the Medical or Clinic Director must review a billing sample at least once every 30 days, maintain a record of the review, and document corrective action for any fraudulent or unlawful billing found. This is a billing-review requirement — not a universal “monthly chart audit” rule.

Open the full explanation2 sections and primary sources

What does the billing review involve?

A periodic sample of clinic billing, a record that the review happened, and documented corrective action where billing problems are identified.

Is the 30-day billing review the same as a monthly chart audit?

This 30-day billing review is sometimes mis-stated as a blanket monthly chart-audit obligation for every clinic. Chart and quality review are valuable governance tools, but the specific 30-day cadence here is about billing under the AHCA framework.

Primary sources

Review the cited source before applying the answer to a facility.

How to use this guide

Separate the public question from the facility decision.

First confirm the facility type, AHCA or exemption status, payer model, licensed roster, and services. Then check the current official source and document who evaluates, prescribes, orders, administers, supervises, and escalates an exception.

MFMD can structure facility governance and present the proposed services and responsibilities to a physician. Clinical authority and acceptance remain with the reviewing physician.

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