Coding Audit and Provider Education
A coding audit entails a thorough examination of your coding, billing, documentation, and reimbursement procedures. When it comes to conducting this audit, 4sight stands out as the exclusive nationally recognized trainer of medical auditors.
The auditors at 4sight hold dual certifications as Certified Professional Medical Auditors (CPMA) and Certified Professional Coders (CPC), each boasting a minimum of 15 years of experience. Annually, our auditors carry out over 2000 distinct coding and compliance audits for medical practices and facilities, spanning both national and international locations.
Taking a closer look at our auditing services:
- Identify potential risk areas that may lead to over or under coding and documentation discrepancies.
- Verify that your coding practices align with the regulations stipulated by private and government payors.
- Educate your providers and staff on using documentation for compliance and securing accurate reimbursement.
Customized Solutions for Each Client
- Account Oversight by a Dedicated Executive.
- Scrutiny of Each Claim for Accuracy.
- Evaluation of Benefit Eligibility
- Management of Prior Authorization Processes.
- Guidance and Support through Patient Financial Counseling.
- Legal Intervention When Necessary for Denied Payments.
- Thorough Reimbursement Reviews and Audits.
- Verification of Professional Credentialing.
- Streamlined Enrollment Procedures.
- Negotiation and Contracting with Insurance Providers.
- Ensuring legal compliance for optimal collections in complex payer environments.
- Specialized Coding Tailored to All Modalities and Specialties.
- Strategic Financial and Testing Mapping for Fee Optimization.
- Streamlining billing and claims for primary and secondary payers.
- Active Accounts Receivable Follow-up for Payers and Patients.
- Expertise in Handling Appeals and Denials.
- Management of Workers’ Compensation and Disability Matters.
- Using HFMA-based KPIs for outcome-focused financial well-being
FAQs – Coding Audit & Compliance Services
A coding audit is a systematic review of medical coding, billing, documentation, and reimbursement practices. It ensures compliance with industry regulations, identifies potential risks, and safeguards revenue integrity by preventing coding errors that can lead to claim denials or legal exposure.
4sight is the exclusive nationally recognized trainer of medical auditors, backed by a team of dual-certified professionals (CPMA and CPC) with a minimum of 15 years of experience. We conduct over 2,000 audits annually, offering unparalleled expertise and precision in compliance evaluation and coding accuracy.
Our audits encompass coding accuracy reviews, compliance assessments, risk analysis, and documentation audits. We address both inpatient and outpatient services, including specialty-specific audits for hospitals, clinics, and physician practices.
A comprehensive audit identifies areas of undercoding, overcoding, and documentation gaps. This allows providers to implement corrective measures, ensure compliance with payor and regulatory guidelines, and secure accurate and timely reimbursements.
Yes. Every client engagement is tailored to their operational model and specialty. We provide dedicated account oversight, claim-level accuracy checks, financial mapping, payer negotiation, and legal compliance support to achieve optimal results.