Auditing

 
Our trained and experience professionals are ready to assist with all of your auditing needs. Our standard audits are listed below, however we are more than happy to customize audits to better meet your organization’s needs.
COMPLIANCE AUDIT
Our experienced auditors will review a representative sample of your organization’s coded medical records to determine accuracy and completeness of the ICD-9-CM diagnosis and procedure code assignment and sequencing. Results will be documented in a written report and discussed with your leadership.
 
APC & DRG VALIDATION AUDITS
AE’s experienced auditors will review a representative sample of charts which can include APCs and DRGs that are generally problematic or those which have been problematic for your facility. Attention will be given to codes assigned by coding staff in addition to codes assigned by the charge master and can include emergency department visits, ambulatory surgeries, hospital-based clinic visits, radiology, and interventional radiology. Our auditors will document their findings in a written report which will be reviewed with your organization.
 
RECOVERY AUDIT
AE’s skilled auditors will perform a coordinated audit utilizing the medical record and UB92 itemized bill to identify reimbursement errors. Our auditors will work with your staff to initiate recovery and to initiate follow-up appeals of identified errors.
DENIALS MANAGEMENT Minimize
The team’s rigorous approach to every denied claim includes an in-depth investigation by our clinical review team consisting of physicians, registered nurses, clinical documentation specialists, certified medical coders, and financial analysts. Whether working to prevent denials, or writing an appeal letter for payment of a clinical denial, we ensure no stone goes unturned.
 
AE & Associates offers a full complement of medical auditing services including:
  • minimizing compliance risk while optimizing revenue
  • MS-DRG and APR-DRG validation
  • RAC Audits & Appeals
  • Medical Necessity review (commercial plans &Medicare/Medical)
  • identifying coding issues
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