Coding Audits (Pro/Fee & Facility)

02 Oct Coding Audits (Pro/Fee & Facility)

Ensuring Accuracy, Compliance, and Revenue Integrity

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Why Coding Audits Matter More Than Ever

Healthcare providers operate in a world of increasing payer scrutiny and rising compliance risk. Whether it’s professional fee (Pro/Fee) services or facility-based billing, accurate coding is the backbone of your revenue cycle. A single error or missed code can trigger denials, revenue leakage, or even regulatory audits.

Industry Stats:

• Up to 80% of medical bills contain errors (AMA study).
• 3–10% of revenue loss occurs annually due to coding inaccuracies.
• CMS penalties for improper coding have reached into the billions nationwide.

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The Financial Upside of Coding Audits

When providers implement structured Pro/Fee and facility coding audits, the financial results are transformative:

• Revenue Recovery: Capture 3–7% of missed reimbursements annually.
• Compliance Assurance: Avoid penalties from OIG, MAC, and commercial payers.
• Productivity Boost: Educate coders & providers, reducing recurring mistakes.
• Data-Driven Improvement: Identify patterns, optimize documentation, and improve E/M leveling accuracy.

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The Risks of Not Conducting Audits

Failing to perform consistent coding audits exposes providers to significant risks:

• Increased Denials → Delayed payments and added staff workload.
• Regulatory Scrutiny → Greater likelihood of OIG/MAC/UPIC reviews.
• Revenue Leakage → Chronic underbilling or miscoding erodes profitability.
• Provider Frustration → Lack of feedback loop leads to repeating costly mistakes.

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Project Requirement Snapshot

This service is delivered as a structured project engagement with clear deliverables.

• Type: Project (Pro/Fee & Facility Coding Audits)
• Step-by-Step Process: Chart sampling → Audit review → Error categorization → Provider/coder feedback → Compliance reporting
• Timeline: Typically 4–6 weeks (scalable by practice size)
• Expected Result: Reduced denials, higher coding accuracy, compliance readiness
• Setup Fee: Yes (varies by practice size and scope)
• Requires Access to EMR: Yes
• Deliverables: Yes – full audit report, provider education session, compliance dashboard
• Requires Ongoing Subscription: Optional (quarterly or biannual audits recommended)

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What Happens After You Sign Up?

We make onboarding seamless so you know exactly what comes next:

1. Project Created Automatically in our workflow system.
2. Assigned to a Project Manager (Account Specialist) who oversees your audit.
3. Client Portal Created for ongoing project review, document exchange, and progress tracking.
4. Introductory/Discovery Call from your Account Manager to discuss timelines, goals, and audit scope.

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Demand Heatmap

(Coding audits are in highest demand in multi-specialty groups, hospital facilities, and physician networks facing increased payer scrutiny.)

• High risk: Primary care & internal medicine (E/M leveling).
• High impact: Surgical specialties & facility billing.
• Growing demand: Telehealth coding accuracy post-COVID.

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Provider Satisfaction Metrics

• 92% of providers report greater confidence in billing compliance after audits.
• 87% saw reduced denial rates within 60 days of implementing structured audits.
• 78% said provider feedback & education improved documentation quality.

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Call to Action

Are you ready to strengthen compliance and stop revenue leakage with Coding Audits (Pro/Fee & Facility)?
👉 Click below to purchase Coding Audits (Pro/Fee & Facility:

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