Medical Auditing

Medical Auditing 2017-11-18T00:53:30+00:00

Medical auditing for maximum reimbursement

Don’t leave money on the table. No matter how efficient you believe your coders are, updates to ICD-10 and changes to risk adjustment methodologies make regular chart reviews and external coding audits critical to revenue cycle success.

Regular external audits give you a fresh perspective for detecting potential holes in your system. Audits and reviews can avoid denials or unwanted RAC reviews, assure appropriate reimbursement and improve coder performance and productivity levels going forward.

Avoid errors and improve financial performance

CODEMED works with you to determine your auditing needs and assigns credentialed experts to help you maintain coding and documentation compliance. We provide an executive summation following each audit. Depending on the results, we may recommend a clinical documentation improvement (CDI) program or staff coding education to improve the quality of your coders’ skill levels and help you maintain excellence.

Chart reviews

We will help you identify problem areas before you submit claims, allowing you to avoid submission errors, capture necessary supporting documentation and make changes to billing or coding, as needed.

Comprehensive coding audits

Our coding audits are performed by highly qualified, credentialed coders using advanced analytics. These external audits assure your compliance with HIPAA, federal/state statutes and regulations, private payer polices, official coding guidelines and accepted standards for HIM and Clinical Documentation Practices.

Risk adjustment coding audits

CODEMED’s auditing experts and analytical professionals will provide a comprehensive assessment of the current state of your HCC capture, making sure that every claim submitted via RAPS or EDPS meets the highest level of specificity, with encounter data that includes the health status, demographic data and severity of illness of each patient population.

RAC reviews and appeals

Don’t assume that because you have been subjected to a RAC audit, penalties are warranted. Our team is equipped to review their findings, handle RAC appeal responses and help you minimize RAC risk going forward. Let us handle the appeals and paperwork so you can provide quality healthcare.