Coding Quality Audit & Compliance Review
MedCodex performs systematic coding quality audits to identify errors, compliance gaps, and revenue leakage in your current coding operation. Our audits produce actionable findings with coder-level feedback, compliance risk ratings, and clear remediation plans.
Types of Audits We Perform
- Prospective Audits: Review coded claims before submission to prevent errors.
- Retrospective Audits: Review historical claims to identify patterns and trends.
- Focused Audits: Targeted review of specific high-risk areas (E&M, surgical, high-dollar DRGs).
- Compliance Audits: OIG Work Plan-guided reviews for regulatory risk areas.
- Coder Performance Audits: Individual coder accuracy measurement and benchmarking.
What Our Audit Reports Include
Every MedCodex audit delivers a comprehensive report covering:
- Overall accuracy rate by coder, department, and service line
- Code-level discrepancies with correct code recommendations
- Financial impact analysis (over-coding and under-coding)
- Compliance risk assessment (low, medium, high)
- Root cause analysis and educational recommendations
- Trend comparison across audit periods
High-Risk Areas We Focus On
- E&M level selection and medical necessity
- Surgical coding and modifier use
- Evaluation of CC/MCC capture for inpatient DRGs
- Query response documentation and coding
- NCCI edit and unbundling compliance
- Place of service and type of service accuracy
Education & Remediation
Audits without education don't improve performance. MedCodex provides coder-specific education sessions, written feedback, and follow-up audits to track improvement. We partner with your coding leadership to build a culture of continuous quality improvement.
Regulatory Compliance Support
We align our audits with OIG guidance, RAC focus areas, MAC LCD/NCD policies, and payer-specific guidelines. Our compliance-focused approach helps your organization avoid costly takebacks, audits, and penalties while maximizing legitimate reimbursement.