Are maintaining accurate medical coding becoming overwhelming for your in-house coding team? Inaccurate or outdated codes are the leading factors for denied claims, causing significant financial loss and potential compliance issues for healthcare institutions.
While medical coding serves as the foundation for accurate healthcare billing in healthcare back-office operations, even minor inconsistencies or errors in coding can lead to claim denials, underpayments, regulatory hurdles, or even seize revenue opportunities. Medical coding audit services target outdated coding practices, human errors, and a lack of internal oversight, contributing to inaccurate coding.
With 24+ years of expertise in Medical coding services, Suma Soft offers a wide range of audit solutions designed to identify and rectify coding inconsistencies or errors. Our medical coding audit services help healthcare organizations streamline their medical coding audit process by combining advanced audit technology and specialized expertise. This ensures compliance with regulations and optimizes the claims process. Suma Soft’s expert medical coding audit services assist healthcare providers in improving coding accuracy, enhancing compliance, and ensuring timely reimbursements.
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75% Reduction in claim denials
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15% Improvement revenue growth
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80% Reimbursement within 90 days or less
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50% average reduction in Accounts Receivable days
Suma Soft’s Medical Coding Audit Services help organizations optimize their revenue cycle management services by reducing denials and increasing successful claims. Our comprehensive medical coding audit services address your specific requirements, evaluate the accuracy of the medical codes assigned to diagnoses and treatments, and ensure they align with regulatory standards.
Procedural Coding Audits
Medical coding audit services analyze surgical records, physician documentation, and procedure reports, ensuring accurate procedure code assignment based on the CPT (Current Procedural Terminology) coding system.
Diagnosis Coding Audits
Our efficient medical coding audit service coders review, analyze, and verify patient charts and clinical documentation with accurate ICD-10-CM (International Classification of Diseases) diagnosis codes.
Compliance Audit
Our Medical Coding Audit Services experts conduct an in-depth analysis of your coding practices to ensure strict adherence to all HIPAA regulations, E/M coding guidelines, and other relevant industry standards.
Documentation Audits
With medical coding audit services, organizations get access to complete assessments of patient medical records to identify any missing or conflicting information that could impact subsequent claims submission.
Evaluation and Management (E/M) Coding Audits
Specializing in E/M coding used for outpatient visits, our medical coding audit service team evaluates and ensures accurate code selection based on the level of service provided.
Modifier Usage Audits
Our medical coding audit service team carefully reviews modifier usage to verify its appropriateness and compliance with coding guidelines.
Clinical Validation Audits
A clinical review of patient charts and coding is performed based on the documented medical conditions by our certified medical coding audit services professionals to confirm the accuracy of assigned codes.
Coding Education and Training
Our medical coding audit services identify areas requiring coding improvement and provide customized training programs to enhance your staff's coding skills and knowledge.
Denial Management Audits
Our Denial Management Services team analyzes denied claims to identify the denial's root cause and detect if coding errors or other billing issues are the reason for denial.
Revenue Cycle Management Audits
A comprehensive assessment of your entire revenue cycle is conducted to identify inconsistencies. Our medical coding audit team designs optimization opportunities by focusing on accurate coding.
Benefit from a secure and efficient audit process that ensures and prioritizes transparency and data privacy. Our Medical Coding Audit Services provide customizable solutions for healthcare organizations' needs while offering a complete picture of their coding practices. Here's how we conduct our audits:
Patient Charts Access
Securely reviewing patient charts electronically or through secure file transfer protocols to ensure the confidentiality of all protected health information (PHI) throughout the process.
ICD and CPT Coding Review
Review all diagnoses, procedures, and medical services utilizing ICD-10-CM and CPT coding manuals to analyze each encounter and assign accurate codes based on the documented details.
Pre-Coding Implementation & Quality Check
Our medical coding audit service team conducts quality checks using advanced coding software and internal review processes to ensure accuracy and compliance with industry standards.
Coded Charts Submission
Once the audit is complete, our medical coding audit service team submits the reviewed and accurately coded charts back to the healthcare organization for further processing or claims submission.
Feedback and Continuous
Improvement
Post-audit, our medical coding audit team collects feedback, incorporates suggestions, and follows up to continuously improve the quality, efficiency, and effectiveness of audits.
Achieve coding accuracy at the highest level and optimize new revenue opportunities with our medical coding audit services. Suma Soft ensures compliance and maximum reimbursement for healthcare providers by offering customizable solutions for their medical coding audit needs.
HIPAA Compliance
Our medical coding audit services adhere to strict HIPAA regulations to protect sensitive information and prioritize patient data security.
Certified Medical Coders
We ensure accurate and compliant coding by our certified coders with expertise and knowledge.
Advanced Technology
Leveraging cutting-edge technology and software, our medical coding audit team provides a streamlined audit process that improves efficiency and accuracy.
In-Depth Analysis
Healthcare organizations can identify areas for improvement and potential revenue enhancements through detailed insights into their coding practices provided by our medical coding audit service experts.
Customized Solutions
We customize our medical coding audit services to meet the needs of healthcare organizations, whether they require a full-scale audit or a targeted review of specific areas.
Cost-Effective Solutions
Our medical coding audit service team provides efficient processes and competitive pricing while ensuring the best value for investment.
Enhanced Revenue
Healthcare organizations can maximize their revenue and minimize compliance risks by identifying and rectifying coding errors conducted by our medical coding audit service team.
Improved Compliance
Ensure adherence to all relevant coding guidelines and regulations, reducing the risk of penalties and sanctions through our rigorous audits.
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