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Hospital Audits

Comprehensive audit services

Our Auditing Services include several types. Hospital audits include inpatient DRG audits to assess the accuracy of ICD-10 diagnosis and procedure codes and outpatient surgery CPT audits to assess the accuracy of CPT codes assigned to outpatient surgical procedures. We also offer E&M audits for physician practices concerned with RBRVS payments.

The quality and accuracy of medical record coding for reimbursement purposes is essential to the business of healthcare. Regulatory requirements, business Best Practices, and professional ethics demand strict adherence to current coding guidelines. Healthcare providers have a legal, contractual and fiduciary duty to bill accurately and completely for their services. Regular assessments of coding practices and audits of coded charts are key tools for measuring coding and billing accuracy.

Our Audit program is headed by Linda Holtzman, who developed the Provider Audit departments at two Blue Cross plans. She literally "wrote the book" on how Blue Cross performs provider audits. We are able to provide valuable insight into payor audit methodologies, selection criteria and claims edits. We also follow the medical record to the UB-04 for claim submission to payors to verify accuracy through the billing process. After all, there's little value in coding the medical record correctly if it isn't reflected in the bill. Clarity Coding offers comprehensive Audit Services for hospitals and physician practices, covering inpatient, outpatient, and office services. We'll show you where you're doing well and where you can improve.