Medical Claims Audit Overview

Claims Audit Services

Correctly coding and processing medical claims is vital to any provider getting reimbursed for the procedures rendered to patients. It is equally important to avoiding external audits by Medicare and other third party payers as a result of inappropriate charges and/or overcharges.

The only way to verify whether a claim’s coding is appropriate to the services, is to audit the claim by comparing it to the clinical documentation or dictation that was recorded in the chart. A claim audit can reveal whether any variation from average reimbursement is due to inappropriate coding, incorrect submission or processing, as well as failure to followup with denials.

Our claims audit can assist in making the necessary corrections to your medical claims before payers challenge any inappropriate coding, thus expediting your reimbursement process.

Choosing our team to conduct medical claim audits for your practice assures that your coding and processes are appropriate. It also assures you receive a full and complete reimbursement by all applicable payers.

Our claims auditing team will verify:

  • Appropriate procedural codes were applied.
  • Appropriate ICD-9 codes were applied.
  • Appropriate usage of any modifiers.
  • Appropriate linkage of diagnosis to procedure.
  • and more based on information supplied by claims.

In addition to auditing claims for errors prior to submission, our claims specialists can provide an audit of your paid claims to verify full reimbursement. Our team will compare your explanation of benefits (EOB’s) against your paid claims to verify that you have been fully reimbursed for your services.

Each provider and/or practice is unique in their particular needs and expectations from a claims audit, and as such we have devised a system that allows us to tailor our extensive team’s knowledge and attention to detail, to fit the needs of any provider, large or small.

Contact our team so we can assist you in decreasing denials, and increasing your practice revenue.