By leveraging our extensive partner network we’ve developed several different healthcare audits that provide an independent benchmark of current systems to your goals and objectives.
Our Compliance audits are dedicated to maintaining compliance and providing quality and accuracy by coders that are current on HIPAA and Medicare regulations. We do a thorough investigation and develop reports and recommendations based upon our findings.
Our Random Sample Claim audits use a stratified random sample of audit claims to garner a statistical reflection of payment accuracy by identifying overpaid and underpaid claims, claims paid for services not covered and claims that should not have been paid at all. The plan administrator reviews and responds to all identified payment errors and provides input into the audit report.
Diagnosis Related Groups audits are performed on-site or off-site based on the hospital’s or medical practice’s needs. Typically, audits are performed retrospectively, on a quarterly basis.
Our CMS Baseline audit reviews 30 records per provider with a focus on Evaluation and Management codes and documentation. The audit includes review of medical necessity and diagnosis coding that highlights medical decision-making criteria that can impact coding correctness.
