Medical Billing & Coding Audit Services
Ensure Accuracy and Compliance with Your Billing Practices
Providing quality care to your patients is your priority, but are you receiving the revenue you deserve? Mistakes in medical billing can lead to denied claims, lost income, and potential legal issues. This is where MedClaimAssist steps in with expert medical billing and coding audit services.
Our skilled auditors thoroughly review your billing codes to ensure they are accurate, compliant, and optimized. By addressing issues in real time, we help healthcare providers safeguard their practice and improve financial outcomes. Don’t let billing errors put your practice at risk—reach out to us today and ensure your medical billing stays compliant and efficient!
Claim Free Medical Audit
What Are Medical Billing Audits?
Medical billing and coding audits act as essential health checks for your practice’s financial and compliance well-being. These audits involve a thorough review of billing claims and coding documentation to ensure adherence to medical billing regulations. Certified auditors analyze patient records and billing details to confirm that the codes used accurately reflect the care provided and the conditions treated.
Much like routine health checkups that identify potential issues early, audits uncover errors in billing practices, allowing providers to address them proactively. They play a crucial role in identifying improper coding, incomplete documentation, overlooked charges, and noncompliance with reimbursement policies.
By conducting regular and detailed audits, healthcare providers can improve their revenue cycle, minimize the risk of denied claims, and avoid penalties. Comprehensive audits help ensure accurate coding, complete documentation, optimized reimbursements, compliance with payer requirements, and long-term financial stability.
How Does MedClaimAssist Support Medical Coding Audits?
At MedClaimAssist, we specialize in providing expert medical billing audit services to safeguard the accuracy and compliance of your billing practices. Medical billing and coding is a complex process prone to errors, making constant oversight essential. Our coding audit and compliance services act as a protective layer, ensuring the integrity and efficiency of your medical claims billing process.
Our team of experienced billing auditors thoroughly examines documentation, coding decisions, and submitted claims to uncover inaccuracies and identify areas for improvement in your billing cycle. These insights help healthcare providers achieve error-free coding and maximize revenue capture.
Equally important, our robust medical billing audit program mitigates the risk of compliance violations and fraudulent claims, which can result in penalties, fines, and reputational damage. With MedClaimAssist, you can rely on an audit service that supports clinical, financial, and regulatory excellence, ensuring your practice operates at its peak potential.
Check our Medical Billing Audit Solutions
Medical Coding Audit
We perform comprehensive medical coding audits for all types of medical records, including inpatient, outpatient, professional fee (ProFee), and home health services.
Medical Billing Audit
We conduct thorough medical billing audits for all types of claims, including Medicare, Medicaid, commercial insurance, and self-pay accounts.
Government & Payor Mandated Audit
We assist providers in preparing for and addressing audits such as TPE, RAC, OIG, DMEPOS, and Medical Necessity to ensure compliance.
Clinical Audits
We conduct internal and external clinical audits to assess the quality, safety, and outcomes of your patient care, ensuring compliance and improved patient results.
Collection Aging Audit
We improve your cash flow by auditing aged claims for errors and refiling denied claims through our aging collection audit, ensuring quicker reimbursement and less revenue loss.
Auditing Medicare Patient Charts
We audit Medicare patient charts to ensure that every dollar billed is justified and compliant, helping your practice receive full and fair payment.
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We Optimize Your Medical Billing and Coding Processes
Internal Audit
We conduct a thorough review of your internal processes and documentation to ensure industry standards are met, providing recommendations to help improve performance.
External Audit
We conduct an independent assessment of your claims and payments from third-party payers like Medicare and Medicaid, resolving billing disputes, recovering underpayments, and managing aged receivables.
Prospective Audit
We carefully review your claims before submission to ensure they are accurate, complete, and compliant with regulations, helping prevent denials, rejections, and delays in reimbursement.
Retrospective Audit
We analyze your claims after payer processing to identify errors, helping you correct mistakes, appeal denials, and optimize your revenue cycle.
Comprehensive Audit
We take a comprehensive approach to auditing your entire medical practice, reviewing everything from coding and billing to documentation and compliance.
Missing Money? We’ll Find It.
Our specialized audits thoroughly analyze your claims data and billing records to recover improper payments and uncover missed revenue opportunities.
MedClaimAssist Medical Billing Consultancy Benefits
Our Coding Audit Service Ensures Billing Compliance:
Here’s How
Auditing your coding accuracy
Assessing coding accuracy is a core focus of our medical coding audit services. We meticulously review medical charts to ensure that the codes accurately reflect diagnoses, procedures, and complexity levels. Proper coding is essential for correct reimbursement and compliance with industry guidelines. Our audits identify issues such as upcoding or undercoding and provide actionable recommendations for correction. With our expert assistance, healthcare providers can be confident that their coding meets standards and captures the full value of their services.
Improving Your Charge Capture Accuracy
Charge capture is another critical area we assess to ensure your practice is billing accurately. We verify that all services provided and supplies used are properly captured at the correct rates. Missed charges can result in lost revenue. Our auditors carefully compare the medical record documentation with the itemized billing statement to identify any overlooked charges. We provide recommendations to enhance your charge capture processes, ensuring that no legitimate charges are missed and maximizing your reimbursement.
Auditing Your Billing Documentation for Compliance
A thorough documentation review is a key part of our billing audit process. We evaluate whether the medical record clearly and consistently supports the coded claims. Complete and accurate documentation is essential for justifying charges and passing payer scrutiny. Our team identifies any issues, such as vagueness, inconsistency, missing signatures or credentials, and lack of medical necessity. We offer guidance to improve documentation practices, ensuring stronger claim defense and better audit preparedness.
Performing Audits of Provider-Payer Contracts
We also assess the correct application of insurance payer contracts and fee schedules, along with the accuracy of data entered into the billing system. Invalid fee schedules and data entry errors can significantly impact reimbursement. Our audits ensure compliance with payer contracts and offer recommendations to improve billing system accuracy. We cover all critical areas to optimize claim quality and maintain revenue integrity.
Our Coding Audit Services Promise Billing Compliance: Here’s How?
Get Post-Audit Reports Delivered Straight to Your Inbox
We provide detailed post-audit reports to give you a comprehensive overview of your coding and billing operations. These reports offer valuable insights into areas of improvement and highlight any issues that need attention. Here are some of the key reports you can request following an audit:
Charge Capture Analysis Report
This report analyzes your charge capture process to pinpoint areas of revenue leakage. We focus on front-end charge capture issues that result in missed charges and lost revenue. The report offers targeted recommendations to enhance your charge capture accuracy and recover potential revenue.
Coding Audit Report
Our coding audit reviews a sample of charts to identify coding errors and areas for improvement. The audit report includes coding accuracy rates, the financial impact of errors, and identifies education needs for coders. Additionally, we provide a risk analysis to help prioritize your auditing efforts.
Denials Analysis Report
By analyzing your denial data, we identify the main reasons for denials, evaluate the need for appeals, and highlight opportunities to prevent future issues. Our denial report offers actionable insights and strategies to reduce denials and optimize your revenue cycle performance for long-term success.
Compliance Risk Assessment Report
This assessment evaluates your compliance risk in areas like coding and billing documentation, Medicare regulations, and HIPAA. We provide a scorecard to measure your risk exposure and a roadmap to help strengthen your compliance program.
Revenue Cycle Performance Benchmarking Report
How do your KPIs compare? Our benchmarking report contrasts your metrics with industry averages to identify areas for improvement. We evaluate key indicators such as first-pass resolution, net collection rate, A/R days, and more to help optimize your performance.
Medical Chart Reviews and Validations
Medical Chart Reviews
Our clinical auditors conduct various types of medical chart reviews, including inpatient, outpatient, radiology, DME audits, mammography audits, and more. We assess the quality of care provided, ensure compliance with coding and documentation standards, and verify adherence to clinical guidelines.
Risk Adjustment Data Validation
We verify the accuracy of your risk adjustment data, including diagnosis codes, hierarchical condition categories (HCCs), and risk scores. This helps optimize reimbursement, avoid penalties, and improve patient outcomes.
Data Abstraction Review
We extract and abstract relevant data from your medial charts, such as diagnosis, procedures, medications, lab results, and quality measures. We also verify the accuracy of data entry in your EHR or other systems.
Charge Validation
We review your charge capture process to ensure the charges billed to the payers are accurate and supported by the documentation in the medical chart. We also identify and resolve any undercharges or overcharges that may affect your revenue cycle.