Coding Compliance Audits

Periodic third-party coding audits can help you identify and correct deficiencies in your coding processes – revealing missed revenue opportunities or protecting you from a negative payer audit.

For more than 15 years, we’ve been conducting thorough, objective audits for emergency departments around the country. We know not only what problems to look for, but also how to help you remedy them efficiently.

How does it work?
Our specialist auditor will review your documentation and compare E&M codes to those originally assigned to the chart. Data from the evaluation is extrapolated (similar to a Medicare audit) to help you quantify lost revenue on under-billed claims or potential liability from upcoded charts.

Actionable advice
Our final report includes chart-by-chart breakdowns of coding strengths and weaknesses plus holistic recommendations to correct problems. At your request, we can also review superbills, chargemasters and other documentation that may be compromising coding accuracy.

Your audit will:

  • Assess the accuracy of E&M code selection based on available documentation in the ED record.
  • Identify strengths and weaknesses in physician documentation
  • Ensure procedure codes are supported in the ED record
  • Identify overcoding and undercoding issues
  • Ensure regulatory compliance
  • Minimize your risk for fraud/abuse allegations
  • Identify education needs for your coders and physicians
  • Compare your E&M utilization to national and regional averages