Revenue Integrity

Medical Auditing Services You Can Trust.

To Drive Accuracy, Profitability, and Peace of Mind

As the healthcare industry evolves, reimbursement processes are growing in complexity, and receiving prompt and optimal pay for services has become difficult. Nonetheless, your profit margin should not suffer the effects of claim denials, inaccurate billing, improper payments, mounting account receivables, and write-offs.

You have a host of revenue challenges. We have a suite of customizable and scalable auditing solutions. Conducting more than 300,000 audits each year, our expert auditors come with vast experience and multiple certifications in coding, specialty coding, auditing, CDI, and/or healthcare compliance. Every audit we perform consists of multi-tier reviews by a team, custom selected to match the expertise your organization needs.

Medical Chart Reviews

AAPC medical chart review begins with a meticulous comparison of documentation to billed codes —and ends with helping you achieve accurate, liability-free coding that captures maximum reimbursement. Our expertise includes inpatient ICD-10-CM and ICD-10-PCS coding, MS-DRG validation, outpatient ICD-10-CM, CPT®, HCPCS, APC, ED, E/M, and pro-fee coding in over 40 specialties.

Auditing and Coding Support

Risk Adjustment Chart Review

Although over-coded CMS HCC diagnoses aren't presently punitive among commercial payers, organizations stand to lose in large-scale recoupments. Our HCC audit will ensure your documentation supports your diagnoses coding, remedying your compliance risks before payers charge foul. We'll also identify trends devaluing RAF scores and costing you equitable pay. (*expertise in all risk adjustment models)

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Compliance Audits

When errors can lead to exclusions and civil penalties, your organization can't afford to gamble. Our compliance auditors know the regulations and the risks. We stay current and exercise our proficiencies every day. Best of all, we pack an arsenal of tools to ensure our coding compliance audits are complete, effective, and ultimately profitable. We'll also fortify your compliance plan or help you create a new program to keep your organization above reproach.

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Clinical Documentation Improvement Services

If your documentation doesn't accelerate your billing cycle, reduce claim denials, and increase your revenue, we can help. Accurate and thorough clinical documentation is a strategic imperative in today's healthcare landscape. Bring in our CDI specialists to assess your provider documentation and reap the rewards of an effective CDI program.

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Post-Audit Education & Training

Overcome your reporting shortfalls — whether your organization has been challenged by E/M coding, encounter details, medical necessity, level of specificity, shared/split visit documentation, or guideline requirements. Our customized training services deliver concrete results and will guide your team over the reimbursement and regulatory hurdles in your path.

Available onsite or remotely, our flexible training options include post-audit education, provider training, HCC risk adjustment training, and specialty or focused education tailored to your staff and patient population. A dedicated project manager and our expert team of certified coders, auditors, and trainers will set you on the path to success, helping you to:

  • Understand and correct documentation gaps
  • Identify process improvement opportunities
  • Optimize EHR usage
  • Affirm or correct code selections
  • Reduce stress from the unknown
  • Direct provider attention to patient care

Specialty Experts for Exceptional Performance

We make exceptional easy with best-in-class coders for every specialty.

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    Medical Coding Services

    From full outsourcing to project work, we provide coding services for every size of organization and all healthcare settings. Our deep expertise in over 40 medical specialties means we're prepared to address your unique reporting challenges and deliver superior results.

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    Revenue Cycle Management

    Accelerate and increase your cash flow by partnering with the experts. We can assist you in a number of services related to revenue cycle management — including coding, charge entry, claim edit and claim denial management support. Additionally, we also conduct RCM audits and training to assess the overall health of your revenue cycle process.

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    Charge Description Master Maintenance

    CDM updates and maintenance enrich the revenue cycle, improve financial forecasting, and certify data reliability and compliance. A fully maintained CDM is a necessity for every healthcare facility.

Coding & Auditing Resources

Stay in the know with AAPC to eliminate risks and improve your revenue.

  1. b2b ebriefs

    Search from numerous free, downloadable eBriefs that will answer your most challenging on-the-job questions related to coding and auditing.

  2. b2b webinars

    Watch this series of 30- and 60-minute on-demand presentations, delivered for free by our Medical Coding Audit Services team.

  3. b2b podcasts

    Listen to the podcast series, Compliance Conversations, where industry thought leaders explore all things compliance, from providing telehealth services to E/M coding risks.

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    This series on auditing and coding best practices provides a straight-forward approach to solving complex issues, including modifiers and proper documentation rules.

Your Partner in Federal and Private Payer Audits

Don't face Medicare, Medicaid, or third-party payer audits alone. We have the expertise to lessen the cost of liability.

  1. Special Investigations

    If payer audit leads to a repayment request, let us validate the accuracy of audit findings before you write the check. We often identify errors in the review that reduce repayments. In worst case scenarios, we can help you avoid future repayments by teaching your staff how to correct trends in documentation and coding.

  2. Litigation Support/Medical Coding Expert Witnesses

    If your organization requires litigation support — oral or written testimony for depositions — we'll provide you with medical coding expertise to defend UCR, medical necessity, and other billing, coding, and documentation issues.

  3. Independent Review Organization

    If your organization is required to participate in a corporate integrity agreement, we work with a variety of government agencies and attorneys general throughout the U.S. and can serve as your IRO (Independent Review Organization).

What Distinguishes Our Audit Services from Other Healthcare Coding and Auditing Companies?

  • We conduct more audits annually — over 300K — than most medical coding auditing companies. And more experience on our end means greater confidence and better results on your end.
  • We don't dispatch a solo auditor and expect him or her to "do the job". We hand-select a team of professionals with the precise expertise your organization needs to achieve optimal results. Our audit service teams include a project leader, auditors, quality reviewers, and support staff.
  • We work with an audit quality committee and invest in monitoring our audits and our auditors. We routinely evaluate our staff and provide them with quality performance reviews.
  • All staff receive annual HIPAA and security training. We follow stringent workflow processes when handling PHI, and our software and tools are HIPAA certified and cyber tested.
  • We consider ourselves your advocate, an extension of your staff. We encourage you to vet us as you would a job candidate, and we will gladly provide you with a list of references. Within our partnership, we will help you establish a roadmap of where you want to be in one year, two years, three years — and we will help you get there.

Frequently Asked Questions

Have a different question? Submit inquiries through our contact page.

Medical auditing is a review of a patient medical record to ensure documentation meets compliance requirements for medical necessity and coding accuracy.

The industry allows the use of either guideline. Both guidelines have pros and cons, it depends upon the nature of the presenting problem in which a patient is being seen by a healthcare provider. The best way to determine what is most advantageous is to compare the two versions.

For a baseline compliance audit, 10-15 patient charts is an industry-standard. For a focused audit, the sampling should increase to 10% of the eligible charts.

Risk Adjustment is a healthcare payment model that reimburses health plans that disproportionately attract higher-risk populations (patients) by transferring funds from lower-risk populations to higher risk populations. Both the insurance plans and physicians share in the risk for caring for patients, therefore both can participate in Risk Adjustment.

A score of 90% or higher is the most common threshold used to set the standard of performance by which organizations can measure and monitor coding accuracy.

See what a specialist can do for you.