Medical Coding and Audit Services

Identifying and rectifying coding errors is crucial to ensure accurate payment, minimize claim denials, and maximize reimbursement. Our team is adept at spotting shortcomings and promptly addressing them, guaranteeing optimal revenue generation. Your organization can improve its coding processes by using our knowledge and learning from our experts. This improvement will lead to better financial results and increased revenue.

A Coding Audit is an internal or external review of a medical office’s coding practices conducted by reviewing patient medical records. Medical record audits target and evaluate procedural and diagnosis code selection as determined by physician documentation for completeness and accuracy.

Scope of Coding Audits

A coding auditor looks at several factors in medical office claims, including:

  • Assess the proper use of CPT codes

  • Determine the correct places of service

  • Look for missing and/or incorrect use of modifiers

  • Detect incorrect diagnoses (i.e., does not indicate medical necessity)

  • Identifying coding and documentation accuracy, trends, and deficiencies (if any)

  • Verify if supporting documentation is adequate to describe the care provided to the patient

  • Identify any bundling or cluster issues (CCI edits and LMRP)

  • Determine if services are reasonable and necessary

Results from the audit are discussed in terms of coding accuracy. Consistent accuracy rates of 95% or higher for physicians are recommended by the HHS Office of the Inspector General (OIG).

Medquik Solutions helps healthcare providers improve their coding practices by offering comprehensive coding audits and improvement services. This helps with accuracy, documentation, revenue, coding risk, and compliance.