Our professional and facility coding audits are performed by highly experienced and AAPC/AHIMA certified coding experts that will identify any potential problems with billing documentation and coding accuracy.
Coding Audit Overview & Workflow
- Design the review based on the desired number of encounters for each coder, provider or clinic.
- Review coding audit scoring methodologies and/or the method of quantifying and identifying priority risk areas on which to focus during the review and follow-up education, if desired.
- Review the existing coding workflow to ensure adequate understanding of the current process(es).
- Create and publish a audit schedule that identifies the approximate timeframe that each audit cycle will be completed.
- Finalize the process and schedule for returning audit results to your Project Lead.
- Receive documentation from client via several secure methods, including cloud storage, SharePoint, and remote systems access. We can also assist in the sample selection process if desired.
- Audits are assigned to our auditors matching the type coding performed with an auditor that has extensive specialty experience in that area.
- A quality assurance audit is performed to make sure that the findings are verified.
- CodingAID will report audit results. We will work with your team to ensure the reporting is customizable, flexible, and easy to access.
- An audit debrief call is scheduled to review findings and answer any questions.
- Follow-up educational opportunities will be scheduled, if desired, for physicians and coders based on high-risk areas, coding guidelines, documentation improvement and industry trends.
Our program is designed to strengthen your compliance and coding accuracy through detailed reviews, reporting and education. We work within your framework and in line with national guidelines to inform and educate your team to achieve optimal compliance and documentation.
Our performance & reputation are built on:
- The dependability, knowledge, and experience of our team
- Our exceptional quality and service delivery in coding support, coding audits, and education
- Our consistency and timeliness in meeting client goals
- Our reliability in communication and service adaptability
- Our ability to partner with clients and become a trusted resource
Our professional coding and audit experts are highly qualified to report and educate on coding guidelines, documentation best practices and more.
- 10+ years in experience performing coding audits, identifying compliance risks, documenting trends, providing education, and reviewing complex and highly specialized cases
- Certified in CPC, CCS, CCS-P, CDIP, CCDS, RHIA, RHIT, CPC, COC, RN, LVN and similar credentials
- Familiar with various EMR systems (Next Gen, Meditech, Cerner, Epic, etc.)
- Experience working at trauma level 1 and teaching facilities where complex and highly specialized cases are routine
Key Professional Coding Audit Focus Areas
- Evaluation & Management Services
- Modifier 25
- Radiology Diagnostic Services
- Physical/Occupation Therapy
- Teaching Physician Guidelines
- Locum Tenens
- Clinical Documentation Improvement
- Multi-Specialty Procedures/Surgeries
- Lab/Pathology Services
- Oncology Infusion Services
- Incident-To/Split-Shared Services
- Cloned Notes/Copy + Paste
- Medical Necessity
Key Facility Coding Audit Focus Areas
- Inpatient Stays
- Outpatient Surgeries
- Emergency Department
- Ambulatory Surgery Centers
- Outpatient Clinic Visits
- Lab Services
- Radiology/ IVR
- Physical/Occupation Therapy
- Nursing Home Services
- Home Health
- Dialysis Center
Through our Federal Supply Schedule contract vehicles and Blanket Purchase Agreements we have been able to assist our government partners in performing an independent review of accuracy and compliance of coding.
We validate reportable assignments of ICD-10, CPT, HCPSC, E/M, POA, APR and MS-DRG and APC.
Our comprehensive approach covers all specialties, all types and any volume. Our external coding audits provide opportunities for our clients to improve their financial performance, meet regulatory requirements, increase cash flow and streamline operations.
Since 1994, CodingAID has been partnering with healthcare organizations nationwide to help ensure both coding compliance and accurate reimbursement. Learn more about CodingAID here.
Connect directly with our team to learn more about our coding audit services.