We begin with a collaborative kickoff workshop to define your audit’s scope, goals, and success metrics. By aligning objectives with your organizational priorities, whether that’s reducing denials, enhancing documentation, or ensuring compliance, we tailor our sampling strategy and timeline to fit your workflow. This phase also establishes clear reporting deliverables and stakeholder roles to keep the project on track.

Leveraging data-driven algorithms, we develop a statistically valid sample that balances random selection with targeted review of high-risk specialties and providers. Our risk stratification model assesses factors like claim volume, historical error rates, and payer-specific vulnerabilities to prioritize records with the greatest financial and compliance impact. This focused approach ensures efficient use of audit resources and maximizes recovery opportunities

Certified auditors meticulously compare clinical documentation to assigned ICD-10, CPT, and HCPCS codes, verifying that each code is supported by the medical record and adheres to payer and CMS conventions. We conduct multi-layered reviews, peer check, manager oversight, and final quality validation, to catch undercoding, overcoding, and modifier misuse. Any gaps are flagged for immediate feedback, reinforcing correct practices at the point of care.

Our AI-powered analytics platform scans audited records to detect patterns, outliers, and systemic coding anomalies in real time. By aggregating error types, such as insufficient documentation, incorrect code sequencing, or missing modifiers, we pinpoint root causes and quantify their financial impact. Interactive dashboards visualize trends, allowing your team to see where improvements will yield the highest return.

Upon audit completion, we deliver a comprehensive report that details error rates by provider, specialty, and code category, alongside prioritization of corrective actions. Each finding is accompanied by clear recommendations, educational resources, and workflow enhancement suggestions. We also conduct a debrief session to review results, answer questions, and co-develop a customized remediation roadmap.

To sustain progress, we implement an ongoing monitoring framework that re-audits key areas at defined intervals and tracks KPIs such as denial rates, coding accuracy, and documentation completeness. Quarterly check-ins and refresher trainings keep your team aligned with evolving regulations and internal quality benchmarks. This continuous feedback loop ensures lasting improvement and guards against future compliance risks.