Service · The retrospective measurement
A coding audit is a measurement, not a repair.
Every practice believes its coding is fine until someone actually pulls the charts and scores them against the documentation. Our AAPC- and AHIMA-certified auditors re-adjudicate every code on a statistically meaningful sample, quantify both over- and under-coding in dollars, and map your exposure against active OIG and RAC targets — all inside HIPAA and SOC 2 Type II systems, with a dedicated account manager and a free 360° reporting dashboard.
Leaves earned revenue on the table across thousands of encounters — and because it looks conservative, it can go undetected for years.
Inflates today's revenue while building a liability that surfaces as a payer audit, an extrapolated recoupment, and in the worst case a False Claims Act problem.
A coding audit is a measurement, not a repair. Its job is to tell you the truth about the codes already on your claims — how accurate they are, how much revenue they are quietly losing or over-claiming, and how much compliance risk they carry — so you can act on evidence instead of a hunch. That scoring is the entire deliverable here.
A periodic, sampled assessment of the accuracy of the codes on your claims — scored against the documentation that was supposed to support them.
That is our pre-bill coding quality review — the continuous, every-claim internal QA gate rather than a periodic assessment. The audit tells you where you stand; the quality review keeps you there.
That is our full revenue-cycle billing audit and consultation — eligibility, denials, A/R and posting across the whole cycle, not coding accuracy alone.
Looks back at claims already paid to find recoverable dollars and repeatable errors.
Reviews coding before those claims go out, catching problems while they are still easy and inexpensive to fix.
The exposure runs in two directions, and both cost money. Under-coding leaves earned revenue on the table on thousands of encounters, and because it looks conservative, it can go undetected for years. Over-coding is the more dangerous failure: it inflates today's revenue while building a liability that surfaces as a payer audit, an extrapolated recoupment, and — in the worst case — a False Claims Act problem. A retrospective coding audit quantifies both, so you recover the revenue you missed and correct the patterns that invite a takeback.
Our medical coding audit services deliver either timing, or both on a rotating schedule.
We do not spot-check a handful of easy codes and call it a pass — we test the specific decision points where documented revenue and compliance actually turn. The table below shows what each engagement evaluates and the rules we score against.
| Audit focus | What we test | Rules and code areas checked |
|---|---|---|
| E/M leveling | Whether the visit level matches documented decision-making or time | 99202–99215, 99221–99239, time-vs-MDM support |
| Modifier integrity | Whether each modifier is supported and correctly applied | -25, -59, -26/-TC, -50, -76/-77 justification |
| Procedure & bundling | Whether procedures survive the payer's automated edits | NCCI pairs, MUE unit limits, add-on/base logic |
| Diagnosis specificity | Whether diagnoses are specific and support the service | ICD-10-CM specificity, laterality, CPT linkage |
| Drugs, supplies & DME | Whether units and product codes are captured correctly | HCPCS Level II, J-code units, NDC crosswalks |
| Risk adjustment (if applicable) | Whether chronic conditions are recaptured and defensible | HCC capture, RAF support, RADV readiness |
| Compliance exposure | Whether patterns match active audit targets | OIG Work Plan, RAC/TPE focus areas |
Because one team scores all of it against the same documentation, the findings reconcile. We can tell you not just that an E/M level was unsupported, but whether the diagnosis behind it was specific enough to carry medical necessity in the first place — the kind of connected finding a single-issue spot check never produces.
The most important thing an audit can be is independent. When the people who assigned the codes also grade them, the result is not an audit — it is a self-review, and it reliably misses the patterns that matter most. Bringing in an outside team removes that blind spot: our auditors have no stake in the codes they are scoring, so the report reflects what the documentation actually supports rather than what anyone hoped it would.
Outsourcing the audit also gives you scale and speed you cannot easily staff internally. A meaningful review means pulling a statistically useful sample across providers, payers, and service lines, scoring each chart against current guidelines, and turning it into a report a physician will actually read — work that stalls the moment your own coders get busy with the daily queue. As a professional audit team, we absorb that load and deliver on a fixed timeline.
This engagement audits your coding — the accuracy of the codes on your claims. If your revenue problem is broader — eligibility, denials, A/R, or posting leaking cash across the whole cycle — that is a different assessment, handled by our full revenue-cycle billing audit and consultation. Many groups run both, but they are distinct deliverables and we keep them that way so each report stays sharp. As a medical billing services company that has audited coding since 2005, we would rather scope tightly and tell you the truth than sell a bundle that blurs the finding.
Revenue review
We review a sample of your recent coding, quantify where accuracy is costing you revenue or building compliance risk, and show you exactly what a full audit would surface.
A certified audit lead will reach out within one business day.
A certified audit lead will reach out within one business day.
A credible audit follows a repeatable method, so the results are defensible and the next audit is comparable to this one. Ours runs in five stages.
With your account manager, we set the objective — recoverable revenue, compliance assurance, a specific provider or service line — then pull a statistically meaningful chart sample across the providers, payers, and dates that matter.
An AAPC- or AHIMA-certified auditor reads each encounter against the documentation and re-adjudicates every code — E/M level, procedure, modifier, diagnosis, and any drug or supply line — recording where the code was correct, over-coded, or under-coded.
Each claim is scored against NCCI, MUE, medical-necessity, and current-year guidance, and flagged against active OIG and RAC targets — the same rule library that powers our annual coding updates service, so nothing is graded against a superseded rule.
We calculate a per-provider and overall accuracy rate, the net revenue impact in both directions, and an error-rate projection you can act on — the concrete numbers a compliance officer or CFO needs.
Each clinician receives a specific, respectful summary of what to change, and we deliver a corrective-action plan so the next quarter's coding is measurably cleaner than this one's.
That closing step is what separates an audit from a scolding. Findings without education repeat; findings paired with provider-specific coaching are the reason practices that audit with us see an up-to-40% reduction in coding-related denials and cleaner claims feeding a 99% clean-claim rate.
Most coding risk traces to a short list of repeatable patterns. An audit's value is proving which of them are live in your charts and how much each is costing. These are the findings we report most often.
E/M level not supported by documentation
Recoupment and CO-50 necessity exposure on over-coding; lost revenue on under-coding
Re-level to documented MDM/time; provider MDM coaching
-25 or -59 appended without support
CO-97 bundling denials or audit flag
Apply only when a distinct, documented service exists
Unspecified ICD-10 where specificity was available
CO-11 / medical-necessity denials
Code to highest specificity; document laterality
Diagnosis does not support the billed procedure
Medical-necessity denial
Enforce CPT-to-ICD-10 linkage before submission
Procedures billed past NCCI or MUE limits
Bundling denials plus audit exposure
Pre-bill edit screening; unit verification
Chronic conditions not recaptured annually
Understated RAF, lost risk-adjusted revenue
Annual recapture with RADV-defensible support
Consistent over-coding pattern by provider
OIG/RAC recovery and extrapolation risk
Targeted education and prospective re-audit
Reading these on your own claims — with dollar figures and provider names attached — is what turns "we should probably tighten up our coding" into a specific, prioritized plan. That is the point of the deliverable. Request a revenue review
Choosing an audit partner comes down to whether the findings are independent, credentialed, and actually usable. We built the service around all three:
An audit that ends in "coding looks mostly okay" is worthless.
Our auditors code and review against each year's CPT, ICD-10-CM, and HCPCS revisions, so your charts are never scored against a deleted or superseded rule, and every finding cites the guideline it rests on. That rigor is what makes the report defensible if a payer ever challenges it — the correction you make on our recommendation is one you can stand behind. Measurability is the deliverable, not a byproduct. Ours ends in a number — a per-provider accuracy rate, a net revenue impact, and a projected error rate you can track quarter over quarter. When you outsource this assessment to a professional team that reports its own methodology, you manage coding quality by evidence instead of anecdote, and you can hold the trend line accountable over time.
What an audit plus provider education produces:
Our auditors review coding for solo physicians, multi-provider groups, hospital-affiliated practices, and specialty clinics across the United States. Whether you need a one-time baseline before a payer contract, a compliance-driven review after a takeback letter, or a rotating quarterly audit as standing assurance, we scope the engagement to the question you are trying to answer.
A one-time baseline, so you enter a negotiation knowing what your coding actually supports.
What decides the scopeThe question you're answering
A compliance-driven review after a takeback letter, to find out how deep the pattern goes before the payer does.
What decides the scopeHow far the pattern runs
A recurring audit as standing assurance, comparable quarter over quarter because the method does not change.
What decides the scopeComparability over time
A claim priced on time units, a dialysis month, an interventional procedure living on modifiers, and a session with place-of-service nuance each demand a different auditing instinct.
What decides the scopeAn auditor who knows the work
An auditor who scores them all the same way misses the very errors that matter. We assign auditors by specialty precisely so the person grading your chart already understands how your work is documented and reimbursed.
Onboarding begins with the revenue review — before you commit to anything.
We review a sample of your recent coding, quantify where accuracy is costing you revenue or building compliance risk, and show you what a full audit would surface.
We agree on scope and sample size, connect securely to your systems, and deliver findings on a fixed timeline — typically within days of receiving the charts.
Your account manager stays with you through the readout, and your dashboard shows the results.
You leave with a prioritized corrective-action plan whether or not you engage us for ongoing work.
Every practice believes its coding is fine until someone actually pulls the charts and scores them. Get a per-provider accuracy rate, a net revenue impact in both directions, and a prioritised corrective-action plan — independent, credentialed, and yours to keep whether or not you engage us further.
Related: pre-bill quality review · medical coding services · annual coding updates