Medical coding audits
Medical coding audit services that find errors, risk and missed revenue
Are your providers coding correctly? A (Company Name) coding audit reviews a sample of your charts and claims against documentation and current guidelines, then shows you exactly what’s costing you money or putting you at risk, and how to fix it.
Audit findings summary
E/M levels
Under-coded visits
Modifier 25 use
Not supported
Diagnosis specificity
Needs improvement
Missed charges
Services found
Documentation
Provider feedback
Corrective action plan
Included
Example of the findings summary you receive after an audit.
Coding problems you can't see without an audit
Most coding issues don’t show up as denials. They show up as lower payments, payer audits or recoupments months later. An audit brings them into view.
Revenue lost to under-coding
Providers who code conservatively can leave significant revenue on the table on every visit.
Hidden over-coding risk
Codes that documentation doesn't support can lead to payer audits, refunds and penalties.
Weak documentation
Notes that don't support medical necessity or E/M levels put every claim at risk.
Modifier misuse
Overuse or misuse of modifiers is a common target for payer reviews.
Inconsistent coding between providers
Different providers coding the same services differently signals a problem payers notice.
No clear picture of accuracy
Without regular audits, you don't know how accurate your coding really is.
Our medical coding audit service
Our certified auditors review a sample of encounters for each provider, comparing documentation, codes and claims against official guidelines and payer policies.
You receive a clear report with accuracy scores, financial impact, risk areas and practical recommendations, followed by a review call and provider education.
- Pre-bill (prospective) coding audits
- Retrospective (post-payment) audits
- E/M level audits
- Procedure and surgical coding audits
- ICD-10-CM specificity and medical necessity review
- Modifier usage review
- Provider-level accuracy scoring
- Financial impact of findings
- Compliance risk assessment
- Detailed findings report
- Provider education sessions
- Follow-up audits to track improvement
Our coding audit process
A clear, structured audit from scope to improvement.
Step 1
Define the scope
We agree on providers, services, time period and sample size.
Step 2
Collect records
We securely access the selected notes, codes and claims.
Step 3
Audit each encounter
Certified auditors compare documentation and codes against guidelines.
Step 4
Report findings
You receive accuracy scores, financial impact and risk areas in a clear report.
Step 5
Educate and improve
We walk through findings with your team and re-audit to measure progress.
Types of coding audits we perform
Choose the audit that matches your goals, or combine several into a complete review.
Pre-bill audits
Claims reviewed before submission to stop errors.
Retrospective audits
Paid claims reviewed to find risk and missed revenue.
E/M audits
Visit levels checked against MDM or time.
Procedure audits
Surgical and procedural coding reviewed.
Modifier audits
Modifier use checked for accuracy and support.
New provider audits
Early review for newly hired providers.
Payer-focused audits
Preparation for payer reviews or record requests.
Risk adjustment review
Diagnosis capture and HCC documentation.
What your practice gains
A coding audit protects your practice from risk and recovers revenue you didn’t know you were losing.
Find missed revenue
Identify under-coded visits and services that weren't billed.
Reduce compliance risk
Catch unsupported codes before a payer does.
Better provider documentation
Targeted education improves documentation and coding over time.
Measurable accuracy
Know your coding accuracy rate by provider and service.
Audit readiness
Be prepared for payer audits and record requests.
Independent review
An outside, objective view of how your practice codes.
Why practices choose (Company Name) for coding audits
A useful audit is objective, specific and actionable. Our audits give you clear answers and a plan, not just a list of errors.
- Certified, experienced coding auditors
- Audits based on official guidelines and payer policies
- Clear reports with financial impact for every finding
- Practical, provider-friendly education
- Follow-up audits to measure improvement
- HIPAA-focused processes and a signed BAA
Areas we audit
We tailor every audit to your specialty, providers and goals.
E/M levels
Procedures
ICD-10-CM specificity
Modifiers
Medical necessity
Documentation
Global periods
Telehealth
Related medical billing services
Coding audits work best alongside these services.
Medical coding
Accurate ICD-10, CPT and HCPCS coding by certified coders.
Claim scrubbing
Every claim checked against payer rules before submission.
Denial management
Denials analyzed, corrected and appealed.
Charge entry
Charges entered accurately within 24–48 hours.
What is a medical coding audit?
A medical coding audit is a review of a sample of patient records and claims to check whether the codes billed are accurate, complete and supported by documentation, based on official coding guidelines and payer policies.
How often should a practice have a coding audit?
Many practices audit at least once a year, with additional audits for new providers, new services or after major coding changes. Higher-risk areas may be reviewed more often.
What is the difference between a pre-bill and retrospective audit?
A pre-bill audit reviews claims before they are submitted, so errors can be fixed first. A retrospective audit reviews claims already paid to find risk, overpayments and missed revenue.
How many charts do you review?
Sample size depends on your goals and number of providers. A common starting point is 10–20 encounters per provider, and we’ll recommend the right scope for you.
What do I receive after the audit?
You get a written report with accuracy scores, findings by provider, financial impact, risk areas and recommendations, plus a review call and provider education.
Will an audit find coding that needs to be refunded?
It can. If overpayments are identified, we’ll explain the findings so you can address them with your compliance advisor and correct future coding.
Find out how accurate your coding really is
Start with a coding audit or a free billing review. We’ll show you where revenue and risk are hiding.