Coding and Reimbursement Audits

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Coding and Reimbursement Audits

We employ Certified Professional Coders and Certified Medical Auditors who have the skill, education, and experience to analyze your documentation and code selection. Our certified professionals identify areas where revenue is not being maximized. At the completion of each audit, we will provide you with a summary of the audit findings and collaborate with you to improve receivables while maintaining compliance with applicable regulations.

You may be asking yourself, “Why should I have an audit?” Audits help to analyze the practice coding, charges, and payments to provide feedback as to the efficiency of the practice’s current work to revenue capture ratio. We have done audits where the providers’ coding and documentation is adequate, leaving the provider with a sense of security that the billing and documentation will pass the test of a payer audit. Payer audits can leave the practice with headaches and large fines.  External audits can prevent large fines and increase reimbursement. In the years past, we have performed audits for providers and identified opportunities for providers to improve their code selection and documentation to maximize their revenue.

  • Have you not had an audit in a few years and would like a general overview of how your practice’s documentation aligns with code selection?
  • Do you have multiple providers and want to be sure they meet documentation and coding requirements?
  • Do you have a specific service you would like an auditor to provide insight and feedback on?
  • Do you have a specific concern and want an audit to provide feedback on this specific concern?

Our RCM auditing team can provide basic and in-depth audits, customized to the needs of your practice.

General Practice Audit

Analysis and feedback of all services chosen at random. This type of audit is great if an audit has not been performed regularly for your practice. This audit will give a glimpse of the entire practice and may identify areas of potential education and direct future focused audits.

Provider Specific Audit

Analysis and feedback of individual providers and services. Feedback from this audit will help ensure your providers are continuing to maximize revenue and remain in compliance across all services.

Service Specific Audit

Analysis and feedback of a specific service(s). The claims data and medical records are examined to determine if the claims are compliant, correctly coded and if all charges are captured. This audit focuses on the relationship between the diagnosis and service code assuring medical necessity.

Custom Audit Package

This audit is a custom fit to your practice needs. This could be a prospective or retrospective claims audit, depending on if you want to look back at claims already submitted or look forward.