Medical coding audits ensure compliance, accuracy, and revenue integrity. The HHS Office of Inspector General (OIG) recommends regular audits to prevent errors, reduce claim denials, and maintain proper reimbursement practices. At MedCycle Solutions, we take a structured, comprehensive approach to medical coding audits, ensuring transparency, compliance, and actionable improvements for your practice.
Our five-step auditing process is designed to identify errors, improve documentation accuracy, and optimize your revenue cycle while maintaining industry compliance.
Step 1: Initial Consultation & Assessment
Every healthcare practice is unique, so we begin with a consultation to understand your specific needs, challenges, and compliance concerns. Whether you require:
- An annual compliance review
- A focused audit on a particular issue
- External validation for internal compliance efforts
We customize our auditing process to fit your specialty, payer mix, and operational structure, ensuring that our evaluation aligns with your organization’s goals.
Step 2: Comprehensive Chart Review
Our certified coding auditors conduct an in-depth review of your medical records to ensure coding accuracy, documentation integrity, and regulatory compliance.
Each chart review includes:
- Evaluation of E/M Levels – Ensuring documentation supports medical decision-making or time-based coding.
- CPT/HCPCS/Modifier Accuracy – Confirm that procedures and services are coded correctly.
- ICD-10-CM Coding – Ensuring diagnosis coding is correct and supported by documentation.
- Charge Capture Validation – Verifying that all billable services are documented and submitted for reimbursement.
- Unbundling Review – Identifying instances where bundled services may be improperly reported separately.
By analyzing these elements, we identify areas where your coding and documentation practices can be improved to reduce denials and enhance compliance.
Step 3: Quality Control & Compliance Validation
Compliance is our top priority at MedCycle Solutions. Our audit team follows official coding and documentation guidelines from:
- The Centers for Medicare & Medicaid Services (CMS)
- The American Medical Association (AMA)
- The American Hospital Association (AHA)
- The Centers for Disease Control (CDC) and National Center for Health Statistics (NCHS)
- ICD-10-CM Coding Clinic & CPT Assistant updates
Our multi-tiered quality control process ensures that audit findings are accurate, consistent, and in line with payer regulations. This step validates coding accuracy and ensures all services are properly documented and billed.
Step 4: Audit Findings & Recommendations
Upon completion of the review, we provide a detailed, structured audit report with:
- Identified coding errors and the rationale behind them.
- Opportunities for documentation improvements to support coding accuracy.
- Areas of potential compliance risk and recommended corrective actions.
- Process improvement strategies to enhance claim submission accuracy and reduce denials.
If requested, we also provide a financial impact analysis, showing how coding variances affect your revenue and reimbursement.
Step 5: Post-Audit Consultation & Education
An audit is only valuable if the findings lead to meaningful improvements. That’s why we provide a comprehensive post-audit consultation to help your team:
- Understand the audit results and their implications for compliance and reimbursement.
- Implement corrective actions to address identified issues.
- Receive provider, coder, and billing staff education to improve future accuracy.
We believe in empowering your team with the knowledge and tools needed to ensure ongoing compliance and revenue optimization.
Why Choose MedCycle Solutions for Your Medical Coding Audits?
- Certified, Experienced Auditors – Our team comprises AHIMA and AAPC-certified coding and compliance specialists with extensive expertise across multiple specialties.
- Custom Audit Solutions – We tailor our audits to meet your specific needs, whether you require full compliance reviews, focused audits, or ongoing monitoring.
- Proactive Compliance Strategy – Our structured audits reduce risks, prevent costly payer takebacks, and prepare your practice for external reviews.
- Actionable Insights for Financial Success – We don’t just identify issues—we provide strategic solutions to improve reimbursement accuracy and revenue integrity.
Take Control of Compliance and Revenue Integrity
Regular medical coding audits are essential for maintaining compliance, reducing financial risks, and optimizing your revenue cycle. MedCycle Solutions’ structured auditing process ensures your practice stays audit-ready, financially stable, and compliant with ever-changing healthcare regulations.