01
Chart Sampling and Scope
Use statistically relevant samples across providers, payer types, and visit classes. Include high-value procedure and E/M categories in each cycle.
02
Documentation-to-Code Validation
Match documented clinical intent, medical necessity, and encounter complexity against billed codes and modifier usage. Validate both accuracy and defensibility.
03
Provider Feedback and Remediation
Translate findings into provider-specific education. Use short feedback loops and follow-up audits to confirm correction and retention.
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Frequently Asked Questions
How often should coding audits run?
Quarterly is common, with added audits after payer policy updates, staffing changes, or EHR template changes.
Do audits only reduce risk, or can they increase revenue?
Both. High-quality audits reduce compliance risk and often uncover missed reimbursement opportunities from under-coding.
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