Medical Coding Audits

 A well-established compliance program mitigates the exposure to compliance risk and lost revenue. Medical Coding Audits is our second most popular service line. 

A few of the common issues medical coding audit services can uncover include the following:

• Under-and-over-coding: Under-and-over-coding is an inaccurate representation of services rendered. 
• Unbundling: When medical code uses multiple CPT codes for a procedure when a single code would suffice, 
• Outdated coding: Medical coders are responsible for knowing multiple sets of code, including ICD (international classification of diseases) from the World Health Organization, CPT codes from the American Medical Association, and HCPCS (Healthcare Common Procedure Coding System) from the Centers for Medicare and Medicaid Services. Those code sets are typically updated annually, and using outdated code can lead to lost revenue.
• Lack of documentation: Medical coding accuracy is independent of medical coders, who can only use the documentation given. The medical coding will be inaccurate if the provider generates documentation with missing or undecipherable details.

Our medical coding audit services use innovation and forward-thinking mythologies and technology to improve; compliance risk, efficiency, profitability, and physician, employee, and patient satisfaction when you partner with an experienced team of subject matter experts. Each auditor has five or more years of experience. 

• We provide Audit Summaries and Bell Curve Reports. 
• Quarterly Training 
• We use ICD-10-CM/PCS Guidelines for Coding and Reporting, CPT Guidelines, AHA Coding Clinic, CPT Assistant, and current Centers for Medicare and Medicaid rules and regulations. 
• Auditors will hold one or more medical coding credentials from AHIMA and/or AAPC. 
• Complete internal audits.
• Ensure compliance with annual HIPAA Training and acknowledge and follow the existence of applicable legal requirements according to the federal Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (collectively "HIPAA").
• Follow all of the HIPAA and Hitech rules.