Coding Compliance Audit Services

MedPartners Coding Compliance Audit Services include:

  • Concurrent or Retrospective Audits
  • ICD-10-CM/PCS Audits
  • MS-DRG, AP-DRG, APR-DRG, and APC Audits
  • CPT/HCPCS Audits
  • E/M Level Audits
  • ProFee Audits

At MedPartners, we firmly believe in the value of auditing through the lens of education. That’s why our coding compliance audits are designed to identify deficiencies that may impact revenue and data quality by focusing not only on incorrect coding but also data abstraction errors and gaps in provider documentation.

Our audit team is made up of highly skilled, experienced, AHIMA-credentialed auditor-mentors who utilize comprehensive coding review software to offer a variety of detailed, in-depth analytical reports to our clients.

MedPartners can develop customized educational programs based on our audit results and can also provide supplemental coding and CDI staff to empower clients to meet their financial and data quality goals.

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Our Coding Compliance Audit Services provide:

  • Objectively Analyzed Operations
    • We help you remedy under- and over-coding, unbundling, poor coding habits, and ensure appropriate billing for documented procedures.
  • Educational Opportunities
    • We uncover trends and identify opportunities for education.
  • Establishment of a Baseline for ICD-10 Coding Quality
    • We analyze the ICD-10 proficiency of your coding team and set benchmarks for future success.
  • Coder Performance Appraisal
    • We provide individual data that can be used in annual job reviews.
  • Measurement of Financial Impact
    • We reveal missed revenue opportunities and possible overpayment issues.
  • Evaluation of Medical Necessity
    • We ensure documentation is sufficient to support the medical necessity of the care provided.
  • Measurement of Effectiveness of CDI Program
    • We review documentation gaps and possible DRG mismatch issues.
  • Case Mix Index Analysis
    • We compare your facility’s CMI data with comparable facilities and review DRG data to identify possible documentation and coding deficiencies, which may negatively impact CMI.
  • Determination of Outliers
    • Our PEPPER report uncovers issues for your facility. We then audit the progression of educational solutions.
  • Review of the Facility Coding Compliance Program
    • We offer additional recommendations to help your program achieve the desired coding outcomes.

 

Additional Benefits of Utilizing Our Auditing Services:

  • Complete Data Quality Review
    • We identify deficiencies not only in coding, but also documentation, which may indicate opportunities for improvement in CDI and Care Management processes.
  • Educational Support
    • We provide a customized education plan to help bridge the gap between the current coding team performance and your desired levels of proficiency.
  • Follow-through Support
    • MedPartners can provide industry leading interim staff throughout the entire mid-revenue cycle to empower clients with the bandwidth and expertise needed to take action based on audit results.

 

MedPartners Coding Compliance Audit Services utilize ReviewMate software

 

ReviewMateReviewMate is a web-based tracking and reporting tool that details coding audit findings. The application organizes audit results and generates summaries and reports. It provides in-depth analysis of coder accuracy rates, detailed statistical summaries, and financial impact reports. This software was created FOR auditors, BY auditors and it is an incredible tool. It reduces the time it takes to perform an audit and provides statistical results quickly with absolutely zero need to use spreadsheets.

 

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