Medical Coding Audits: What You Don’t Know Can Hurt You 


How incorporating coding audits into your practice can improve patient outcomes, communication, and revenue.

Think of medical coding audits as preventive medicine for your practice. Neglecting this important aspect of your operation can lead to claim denials, incorrect reimbursements, revenue leakage, and legal penalties. Inaccurate, and incomplete, coding can also adversely affect patient care, treatment plans, and insurance coverage.

Early intervention, post-documentation review, and attention to policies, processes and procedures can help mitigate substantial risks, achieve greater financial stability, and maintain accurate patient records.

Why Audit?

A  medical coding audit can expose compliance risks, errors leading to lost revenue, and more.

  • Compliance concerns ─ A medical audit can identify and correct under coding, up coding, unbundling, lack of specific, required documentation, and ensure adherence to regulatory requirements set forth by CMS (Centers for Medicare & Medicaid Services), AMA (American Medical Association), and other governing bodies.

  • Lost revenue ─ It’s easy to miss ancillary services and other charges when a busy health center doesn’t have a smooth workflow. A professional audit can identify opportunities to maximize reimbursement by billing for all services rendered.

  • Preventing denied and rejected claims ─ Professional auditors thoroughly review coding practices to improve documentation accuracy, ensure proper code assignment, and provide guidance to continuously improve and streamline billing processes.

  • Updating Coding Systems ─ ICD-10-CM codes are updated every October. CPT codes are updated every January. Sometimes EHR systems will add new codes without deleting old ones. Providers may select what they find in the system, and choose a code no longer in use.
  • Provider training ─ Most providers don’t realize they have coding issues. They may not be aware of specific coding guidelines based on diagnosis. An audit can pinpoint troubled areas that require further training.
Expert Guidance

The  OIG (Office of the Inspector General) compliance program recommends having an external audit at least once a year.

It makes sense to call in specialists  ─ external auditors with the deep knowledge, objectivity and experience to ensure a thorough, unbiased evaluation. That is why more practices and healthcare organizations are relying on outsourcing medical coding audit services to CodeEMR to ensure access to the most up-to-date guidelines, best practices and oversight.

Avoid costly mistakes with a CodeEMR Medical Coding Audit.

Find out how CodeEMR can meet your coding needs and help provide optimal patient care and reimbursement.  Contact Paul Ferrazza, Vice President Coding Business Development, at 401-529-0109 or

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