Service
An audit is a measurement, not an accusation. The point is to find out whether your billed codes match your documentation before a payer decides to find out for you.
A sample of charts is read against the claims that were submitted for them. Findings are reported in both directions — codes billed above what the documentation supports, and codes billed below it. Under-coding is the more common finding and the one that quietly costs the most money.
Your distribution of evaluation and management levels is compared against your own documentation. A distribution skewed hard to one level is worth understanding whichever direction it leans, because it usually reflects a habit rather than the actual case mix.
You get written findings with the specific charts referenced, the pattern each one illustrates, and what to change. An audit that produces a percentage score and no remediation plan has not told you anything you can use.
What is included
| Edit standard applied | NCCI procedure-to-procedure pairs and medically unlikely editssource: CMS, National Correct Coding Initiative |
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Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.
