Preparing for a coding audit: A guide for physicians

Physicians Practice December 20, 2022
Abdul J. Roberts, Esq., Jim Tudor, PCA, CPC

Trends in medical audits and what physicians can expect.

You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. No one has ever given you any trouble before.

Nothing to worry about, right?

Several months pass, and you get a letter from the payer. It’s the results from your audit. You open it up, and see:

• “…medical necessity not supported…”;
• “…notes are cloned…”;
• “…records include conflicting data.”

It also says you owe an astronomical...

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