Coding & documentation audits
Pre-payment or retrospective review of E/M, procedures, modifiers, place of service and medical necessity, by provider and by payer.
04 · Auditing
Practice Auditing & Compliance
Find the problem on your terms, with your consultants, before a payer or the government finds it on theirs.
Engagement at a glance
- Engagement modelFixed-fee project, annual retainer, or per-provider audit
- ScopeSingle service line, one provider, or the whole group
- ReportingWritten report with error rates, financial exposure and root causes
- EducationProvider and staff sessions tailored to the findings
- DefensibilityAudit workpapers retained and produced on request
- Follow-up90-day re-audit and monitoring plan included
10%
Sample size per provider
Statistically useful, small enough to be routine and unthreatening.
30 days
Audit report turnaround
Written findings, financial exposure and a prioritised fix list.
90 days
Corrective action follow-up
Re-audit included so you can show the fix actually worked.
The problem
An audit should be a tune-up, not an ambush.
Payers are pulling records at higher rates than at any point in the last decade, and the most common findings are boring and preventable: a level of service the note does not support, a missing modifier, a signature that never got captured, a supervision requirement nobody tracked.
Our auditors review a statistically valid sample of encounters across every provider, compare what was billed to what the documentation supports, and report the financial exposure in both directions — because under-coding is leakage too.
Beyond coding, we run HIPAA Security Rule risk assessments, OSHA and infection-control reviews, and program-integrity checks covering the Stark Law, the Anti-Kickback Statute and the False Claims Act. Every engagement ends with a written corrective action plan and an owner for each item.
What's included
Everything in this service, in writing.
Billing & revenue integrity review
Charge master and fee schedule review, duplicate and unbundling checks, credit balance review, and refund handling.
HIPAA Security & Privacy assessment
Risk analysis against the Security Rule, policy review, workforce training records, BAA inventory, and breach-response readiness.
OSHA & workplace safety
Exposure control plan, sharps and sterilisation practices, hazardous communication, and required staff training documentation.
Program integrity review
Stark Law and Anti-Kickback analysis of compensation arrangements, leases, referral patterns and ancillary service structures.
Corrective action plans
Prioritised findings with owners, deadlines, education materials, and a 90-day re-audit to confirm the correction held.
How it runs
The engagement, step by step.
01
Scope & sampling
We agree the universe of encounters, the sample size, the risk areas and the payer mix so the audit answers the questions you actually have.
02
Record review
Each encounter reviewed against CPT, ICD-10, payer policy and the documentation itself, with findings recorded per element.
03
Reporting
You get error rates by provider and category, dollar exposure in both directions, and the three fixes that matter most.
04
Education & re-audit
Provider-level education, then a 90-day re-audit on the same measures so improvement is demonstrated, not asserted.
What we hold ourselves to
These are the operational targets we report against for this service. They are industry benchmarks and internal commitments — your results depend on your volume, payer mix and specialty, and we will tell you honestly where you should expect to land.
10%
Sample per provider
< 5%
Target error rate
30 days
Report turnaround
90 days
Re-audit window
FAQ
Common questions.
Is the audit discoverable if a payer sues us?
Audit workpapers can be requested in litigation, which is exactly why we write them plainly and factually. We also advise you on what to do — and what not to document — the moment a payer issues a records request.
Should we audit before or after we fix our coding?
Do a baseline audit first. It tells you whether the problem is coding, documentation or the front desk, and it gives you a defensible 'before' picture. Re-auditing after the fix is what proves the correction.
Do you report us to anyone?
No. We work for you. If we find something serious — a pattern of unsupported claims, or an arrangement that looks like a Stark violation — we tell you immediately and help you remediate and, where appropriate, self-disclose with counsel.
How disruptive is the process?
Minimal. We work from records, not from your waiting room. Providers typically spend 30 minutes in the education session and receive a one-page summary of their own findings.
Can you audit just our new providers?
Yes, and we recommend it. A focused audit in a clinician's first 90 and 180 days catches habits early, when they are cheap to fix.
Related services
Often bought together.
Employee Management & Practice Staffing
Recruiting, onboarding, HR files, payroll and benefits administration, scheduling, policy handbooks and performance management for practice teams.
- Front desk, MA, billing and management recruiting
- Onboarding, HR compliance and payroll administration
- Handbooks, job descriptions and review cycles that hold up
Medical Supplies & Equipment Procurement
Group purchasing leverage, formulary and par-level management, cold-chain and DSCSA compliance, equipment sourcing and inventory control.
- Group purchasing contracts without changing your distributor
- Par levels, usage tracking and waste reduction
- Cold chain, expiry and DSCSA compliance built in
Buying & Selling a Medical Practice
Valuation, brokerage, buyer and seller vetting, due diligence, deal structuring and post-close transition for physician practices.
- EBITDA and comparable-based valuation you can defend
- Confidential marketing and qualified buyer vetting
- Due diligence, structuring and 100-day transition support
Talk to someone who has run this before.
Thirty minutes with an operations lead who works this service every day. Bring your numbers if you have them; we will tell you what we see either way.
A 30-minute call with an operations lead. No obligation, no sales sequence, and we will say so if you do not need us.