Medical coding audits ensure the accuracy, completeness, and compliance of coding procedures in a healthcare setting. They play a vital role in protecting against fraudulent practices and in maintaining the integrity of healthcare data. There are several types of medical coding audits, and they generally fall under two umbrellas – compliance audits and focused audits.
A medical coding audit is a structured review of how patient encounters are documented, coded, and billed — with the goal of ensuring accuracy, regulatory compliance, and reimbursement integrity. These audits are common in the medical coding in USA landscape and may be initiated internally (by the provider or billing partner), externally (by payers), or by federal agencies like CMS and the Office of Inspector General (OIG).
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