Coding & Billing Audit FAQ
Why Coding & Billing Audits Are Critical to Protecting Revenue and Reducing Risk
1. What is a coding & billing audit and why is it essential?
A coding & billing audit is a systematic review of clinical documentation, code assignment, and billing processes to identify accuracy, compliance, and revenue opportunities. TriumpHealth’s audits help reduce risk of payer audits, correct billing errors, optimize reimbursements, and improve documentation quality.
2. What areas are assessed during an audit?
Audits typically focus on:
- Clinical documentation completeness and clarity
- Accuracy of CPT, ICD-10, and HCPCS code assignment
- Compliance with payer-specific rules and CMS guidelines
- Modifier use and appropriateness
- Trends in payer reimbursements and denial root causes
3. What is the methodology behind TriumpHealth’s audit process?
TriumpHealth’s audit methodology is grounded in industry-recognized KPIs and compliance best practices. Our structured approach ensures precision, compliance, and financial integrity.
4. What are the benefits of conducting regular coding & billing audits?
- Improved Revenue Integrity – Capture missed coding opportunities and reduce leakage.
- Enhanced Documentation – Strengthen clinical notes to support accurate charts and billing.
- Regulatory Compliance – Mitigate audit risk by adhering to coding standards.
- Operational Efficiency – Train staff based on audit insights for continuous improvement.
5. How often should audits be conducted?
Audits are often performed annually, but organizations may ramp up frequency based on factors like size, complexity, regulatory changes, or detection of persistent issues.
6. Who performs the audits at TriumpHealth?
Our coding and billing audits are executed by highly experienced, certified professionals (AAPC-certified) with a minimum of 5 years of specialization in the relevant clinical or facility setting.
7. What deliverables can organizations expect from the audit?
- Detailed audit reports comparing original vs. audited code
- Identification of errors such as unbundling, unsupported codes, or modifier misusage
- Insights into denial trends and root causes
- Actionable recommendations for process improvement and staff training
8. How do audit findings translate into improvements?
Audit insights are used to:
- Train and educate coding and billing teams
- Refine documentation workflows and templates
- Address specific coding behaviors contributing to undercoding or inefficiencies
- Decrease claim denials and increase clean claim rates
9. What kinds of organizations benefit from TriumpHealth’s audits?
From small specialty practices to large hospital systems, any organization aiming to improve coding accuracy, streamline billing operations, and secure optimal reimbursement will find our services invaluable.
10. How much revenue can auditing help recover?
Benchmark-driven audit programs have been shown to increase revenue by up to 20% by uncovering missed charges, undercoding, and inefficient workflows.
Need Assistance?
TriumpHealth’s audit services go beyond identifying errors, we provide strategic guidance to strengthen your revenue cycle, sharpen compliance, and boost financial performance.
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Email: [email protected]
Phone: (888) 747-3836 x0
Disclaimer:
The content provided by TriumpHealth is for informational purposes only and does not constitute legal, medical, or financial advice. Regulations and payer requirements may change; please consult a qualified professional for guidance specific to your situation. Click here to review our full legal disclaimer.
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