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.
Why Choose MedCodex for Coding Quality Audit?
Frequently Asked Questions
What types of coding errors and compliance issues does the audit actually look for?
The audit reviews records for diagnosis and procedure code accuracy, correct modifier usage, DRG or APC assignment errors, unbundling, upcoding, undercoding, and payer-specific compliance gaps. Each reviewed chart is checked against current ICD-10, CPT, and HCC guidelines by AAPC- or AHIMA-certified coders holding CPC or CCS credentials. The output is an actionable feedback report that categorizes findings by error type and estimated revenue impact.
How does the free pilot audit work, and how many records are reviewed?
MedCodex will audit a sample of your coded records at no cost and with no commitment required, so you can evaluate the depth and accuracy of the findings before engaging further. The pilot gives you a representative error rate, a breakdown of compliance gaps identified, and a summary of any revenue leakage detected. There is no obligation to continue after the pilot, and no payment is required regardless of the findings.
How is our patient data protected during the audit process, and will a BAA be signed?
MedCodex operates under HIPAA-compliant processes and will sign a Business Associate Agreement before any PHI is accessed or transferred. Auditors work directly inside your existing EHR or billing platform via encrypted secure remote access, so records do not need to be exported or sent via email. No patient data is stored on MedCodex systems beyond what is necessary to complete the audit.
How long does it take to receive audit findings, and what format is the report in?
Standard turnaround for audit findings is 24 to 48 hours per batch of records submitted, depending on chart volume and specialty complexity. Reports are delivered in a structured format that itemizes each error, the relevant coding guideline violated, and a recommended correction, making them usable for coder education and compliance documentation. Your dedicated account manager is available to walk your team through findings and answer follow-up questions.
How is audit pricing structured, and can we use it for an ongoing compliance program rather than a one-time review?
Pricing is flexible and available on a per-chart basis for one-time or periodic audits, or as a recurring FTE-model arrangement for practices that want continuous compliance monitoring built into their revenue cycle workflow. There are no fixed minimum volume requirements disclosed upfront, so pricing is scoped to your actual chart volume and audit frequency. A dedicated account manager will work with you to structure an audit cadence that fits your compliance program goals and budget.