Medical Coding Audit Services
Stay compliant with regulatory standards like CMS and HIPAA by identifying errors in medical coding such as upcoding, undercoding, and unbundling with Invensis's medical coding audit services. We provide comprehensive audit reports with actionable insights and recommendations for correcting errors, help healthcare practices optimize coding accuracy, and minimize the risk of claim denials.
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Streamline Outsourced Coding Audit Services with Invensis
A medical coding audit is a systematic review of a healthcare provider's coding and billing practices to ensure accuracy, compliance, and efficiency in the coding process. The process evaluates the accuracy of the medical codes assigned to diagnoses, treatments, and procedures and ensures they align with regulatory standards related to ICD-10, CPT, and HCPCS codes. Medical coding audits are essential for healthcare practices as they help identify errors, inconsistencies, or potential areas of non-compliance that can lead to claim denials, underpayments, or even legal consequences.
However, many healthcare practices deal with the complexity of medical coding due to the constant updates to coding standards such as ICD-10, CPT, HCPCS, etc. The updated codes, revised guidelines, and changes in billing requirements make it difficult for the in-house team to manage the process effectively. Additionally, the intricate nature of coding for different medical specialties and procedures adds another layer of difficulty, as each requires specific expertise. The burden of keeping up with these changes and managing day-to-day operational tasks overwhelms internal staff and results in coding inaccuracies, claim denials, and compliance issues.
At Invensis, we streamline the medical coding audit process by adopting a comprehensive, multi-layered approach combining advanced audit technology and specialized expertise. Our approach to auditing begins with an in-depth review of all coding practices, including critical coding frameworks such as Evaluation and Management (E&M) services, ICD-10 for diagnosis coding, CPT (Current Procedural Terminology) codes for procedures, and HCPCS (Healthcare Common Procedure Coding System) for medical supplies and services. This ensures that each code is applied accurately and aligns with the latest regulations, guidelines, and payer-specific requirements.
Our expert medical coding audit services help healthcare providers improve coding accuracy, enhance compliance, and ensure timely reimbursements by:
- Conducting a thorough review of current coding practices, including CPT, ICD-10, and HCPCS codes, to identify key focus areas and audit scope based on organizational needs.
- Selecting a sample of medical records, including Evaluation and Management (E&M) services, surgical procedures, and diagnostic tests, for audit, ensuring a diverse range of cases.
- Cross-checking the assigned codes against clinical documentation to verify accuracy, compliance with payer-specific guidelines, and adherence to national coding standards, such as Medicare's NCCI edits (National Correct Coding Initiative).
- Identifying common coding errors, such as upcoding, undercoding, or unbundling, and document patterns that could lead to claim denials, compliance issues, or revenue loss.
- Ensuring that the coding adheres to industry regulations like HIPAA, the Affordable Care Act (ACA), and CMS (Centers for Medicare & Medicaid Services) guidelines to minimize audit risks and legal penalties.
- Providing detailed reports on coding discrepancies and actionable recommendations for error correction, ensuring codes align with updated ICD-10 guidelines and CPT code revisions.
- Using advanced medical coding auditing software and tools, such as 3M CodeFinder, Optum360 EncoderPro, TruCode Encoder Essentials, etc., to automate code validation and flag potential coding issues improves audit accuracy and efficiency.
- Conducting follow-up medical claim audits to assess the implementation of recommended changes and monitor long-term coding accuracy.
Our Comprehensive Medical Coding Audit Services
- ICD-10 Coding Audits
- Coding Accuracy Audits
- Documentation Audits
- Healthcare Compliance Audits
- Risk Adjustment Audits
- Evaluation & Management (E/M) Audits
- Outpatient and Inpatient Coding Audits
- Revenue Cycle Management Audits
- Prospective Audits
- Retrospective Audits
- Charge Capture Audits
- DRG (Diagnosis-Related Group) Validation
- Modifier Usage Audits
- Medical Necessity Audits
- Coding Accuracy Evaluation
- Billing Compliance Audits
- Denial Management Audits
- Specialty-Specific Coding Audits
- Audit for Reimbursement Optimization
- Unbundling and Overcoding Detection
- Recovery Audit Contractor (RAC) Preparedness
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During the consultation, some of the issues we can discuss are:
- Common coding errors, frequent issues like upcoding, downcoding, and unbundling, as well as their impact on revenue and claim denials.
- Industry best practices for coding and auditing and tailored medical billing and coding solutions to meet the key requirements of your healthcare practice.
- Strategies for maximizing reimbursement and reducing underpayments.
- Compliance with regulatory standards such as CMS, HIPAA, and payer-specific guidelines.
Why Choose Invensis as Your Medical Coding Audit Company?
Invensis has over two decades of experience delivering top-tier healthcare coding audit services to healthcare practices worldwide. Our team is adept at overcoming the complexities of coding guidelines, from ICD-10 to CPT and HCPCS, and ensures precise compliance with evolving payer requirements and regulatory standards. We streamline the audit process by integrating state-of-the-art medical coding audit software and methodologies to enhance coding accuracy and reduce manual errors. Our sophisticated approaches result in effective error detection and consistent compliance, driving a 98% accuracy rate in coding assessments. By outsourcing coding audits to us, practices can focus on patient care and clinical excellence.
Here is the list of benefits of outsourcing medical coding audit services:
1. Access to Specialized Expertise: Internal coding teams within healthcare practices may often lack the specialized expertise to manage complex coding cases, particularly when dealing with niche specialties or uncommon medical conditions. They may struggle to interpret intricate documentation correctly, resulting in coding errors that affect reimbursement and compliance.
Outsourcing to medical coding quality and audit services provides access to highly skilled auditors with deep expertise across various medical specialties. These experts are well-trained to manage the complexities of such cases and ensure that all codes are applied accurately and following industry standards.
2. Improved Coding Accuracy: Healthcare practices frequently face challenges in maintaining high levels of coding accuracy. The constant evolution of medical codes and billing regulations can make it difficult to keep pace, often leading to increased coding mistakes, claim denials, and revenue loss, further straining internal resources.
Outsourcing to healthcare audit services ensures that codes are accurate and compliant with the most recent regulations. External experts have the resources to stay updated on changes, ensuring precision and consistently reducing errors.
3. Reduction in Claim Denials: High rates of claim denials are often the result of coding mistakes that internal teams may lack the time or expertise to detect and correct. As the volume of claims increases, internal staff may overlook critical errors, causing more denials, delayed reimbursements, and significant revenue losses.
Outsourcing medical billing and coding audit services greatly reduces claim denials by ensuring that all claims undergo thorough reviews for accuracy before submission. Skilled external auditors can identify and rectify coding issues, leading to fewer rejections, quicker approvals, and improved cash flow for healthcare organizations.
4. Time-Saving for Core Activities: Internal teams are often overwhelmed by the daily demands of coding audits, leaving them less time to focus on core activities, including patient care or operational improvements. Balancing audit responsibilities with their primary duties often diminishes the effectiveness of both.
Outsourcing medical code auditing services allows internal staff to dedicate more time to core business functions. By entrusting audit tasks to external experts, healthcare providers can ensure timely and accurate audits while enhancing in-house productivity for more strategic, patient-focused initiatives.
5. Consistency in Audit Quality: Internal auditing teams may face inconsistencies in their audit processes due to varying expertise levels or changing workloads. These inconsistencies can result in audits that miss critical errors or overlook compliance risks.
Outsourcing healthcare coding and compliance audit services ensures a high level of consistency in audit quality. External providers follow standardized protocols and bring experienced auditors to every engagement. This reduces errors, ensures compliance, and improves the overall quality of the auditing process.
6. Audit Transparency and Accountability: Internal audit processes sometimes lack transparency, with inadequate documentation of errors, corrections, or compliance issues. Without clear accountability, it becomes difficult for internal teams to identify recurring problems or track progress on audit improvements.
Medical coding audit and compliance services deliver a transparent auditing process with comprehensive reporting and detailed documentation of findings. This level of transparency provides healthcare providers with a clear audit trail, enhancing decision-making and accountability in coding practices.
Here are the key trends in medical coding audits:
1. Risk Adjustment Audits: There's an increasing emphasis on risk adjustment audits to ensure accuracy in coding for patients with chronic or complex conditions. These audits ensure that coding reflects the severity of patients' health statuses, preventing underpayments and optimizing reimbursements for higher-risk patients.
2. Focus on Social Determinants of Health (SDOH) Coding: Audits increasingly examine coding related to Social Determinants of Health (SDOH), including socioeconomic factors and living conditions. Properly capturing these codes is crucial for risk adjustment, understanding patient needs, and ensuring comprehensive care and accurate reimbursements.
3. Expansion of Outpatient Audits: With more services shifting to outpatient settings, there's a growing trend toward auditing outpatient coding. These audits ensure accurate billing for outpatient visits, procedures, and diagnostics, aligning coding practices with payer policies for non-hospital services.
4. Global ICD-11 Preparation: As ICD-11 implementation approaches globally, medical coding audits are evolving to prepare for the transition. Medical coding auditing companies are conducting audits to assess readiness, train coders, and ensure compliance with new guidelines that will shape coding accuracy in future healthcare billing.
5. Post-Pandemic Coding Adjustments: Audits focus on pandemic-related changes, such as coding for COVID-19 treatments, vaccinations, and telehealth services. With new CPT and ICD-10 codes, audits ensure proper documentation and reimbursement for pandemic-related care while aligning with regulatory updates.
6. Audits on Bundled Payments: Bundled payment models require accurate coding across the care continuum. Audits increasingly focus on bundled payments to ensure codes accurately reflect services provided, ensuring fair reimbursement and compliance with payer guidelines in episode-based payment systems.
What Our Customers Say
We have been working with Invensis for the past two years, and they have helped us overcome many revenue cycle management challenges. The team often walks the extra mile to ensure that our needs are met.
Invensis has been our revenue cycle management healthcare outsourcing partner for the past 5 years. They have always delivered on their commitments, whether it is meeting our Service Level Agreement (SLA) or improving our billing process.
Invensis has been a great partner providing quality medical coding and billing services. The team is extremely responsive to every query we pose, and the turn-around time for deliverables is always as committed.
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