Medical Auditing

For hospitals and healthcare systems, maintaining precise coding is crucial to maximizing reimbursements and ensuring accurate reporting of the services provided, while also meeting regulatory and compliance standards. At S1 Healthcare, we offer tailored auditing services that support healthcare providers in maintaining coding accuracy across Inpatient, Outpatient, and Professional Fee coding.

Why Choose S1 Healthcare's Medical Auditing?

Our medical coding audits provide valuable insights into the performance and ROI of your in-house coding team, as well as any external coding resources you may be using. By improving coding accuracy, our audits help reduce physician queries and highlight areas for Clinical Documentation Improvement (CDI), ensuring that codes are both precise and aligned with clinical documentation standards.

Flexible Audit Frequency and Sample Size

We understand that each healthcare provider has unique needs. That’s why we offer flexible auditing schedules, allowing you to choose the frequency and sample size that works best for your organization. Audits can be customized to be conducted bi-annually, quarterly, or at any other interval based on your goals. We can focus on specific chart types, individual coders, high-risk cases (e.g., RAC, OIG), or any other areas requiring special attention. You can select the sample size you prefer, or we’ll recommend an optimal sample size based on the type of charts or codes you want audited.

Our Areas of Expertise

S1 Healthcare offers comprehensive auditing services across various specialties. You can select individual audit solutions or combine multiple areas to suit your needs:

• Inpatient Records: Review of ICD-10-CM and ICD-10-PCS assignments, MS-DRG or APR DRG assignment, POA indicators, and discharge status.
• Outpatient Surgery: Auditing of ICD-10-CM, ICD-10-PCS (if applicable), CPT-4 procedure codes, modifiers, and HCPCS codes for ambulatory surgery records.
• Observation Services: Auditing for ICD-10-CM, ICD-10-PCS, CPT-4 codes, and HCPCS codes in observation settings.
• Emergency Department: Review of ICD-10-CM codes, CPT-4 codes, Evaluation and Management (E&M) levels, as well as injections, infusions, and professional or facility components.
• Outpatient Ancillary Services: Audit of ICD-10-CM and CPT-4 codes for ancillary services provided.
• Physician Professional Services: Review of ICD-10-CM codes, E&M levels, CPT-4 codes, and modifiers.
• Clinical Documentation Improvement (CDI): Identifying opportunities to improve documentation quality and reduce physician queries.

All audits are based on official coding guidelines, including Coding Clinics, CPT-4 Assistant, NCCI, NCD/LCD, OCE, and MCE—in addition to customer-specific guidelines that do not conflict with official references. We also consider payer-specific requirements to ensure full compliance.

Additional Focus Areas

If needed, S1 Healthcare can provide audits with a focus on the following areas:

• Validation of Principal Diagnosis & Procedure: Ensuring the accuracy of principal diagnosis and procedure coding.
• Secondary Diagnosis Validation: Verifying secondary MCC, CC, and other reportable diagnoses, as well as logical sequencing.
• Discharge Disposition & Transfer Status: Ensuring accurate documentation of discharge and transfer status.
• Operational Assessments: Identifying incomplete documentation that may impact coding accuracy and workflow efficiency.

We will also document any discrepancies related to:

• Compliance with HIPAA, HITECH, and other regulatory standards.
• Fraud and Abuse Issues: Reviewing for any potential violations.
• Appeals Process Rationale: Assisting in explaining coding decisions for corporate audits, RAC, MIC audits, etc.

Audit Findings & Educational Support

Education and training are key components of any successful audit. We provide comprehensive feedback and training to your team, ensuring that the results of the audit lead to long-term improvements. Our services include:

• Executive Summary: A high-level overview of the audit scope and preliminary findings.
• Final Report: Detailed findings broken down by coder, as well as overall facility performance for MS-DRG/APC accuracy and coding precision.
• Financial Impact Analysis: Understanding how audit findings affect your facility’s financial outcomes.
• Staff Training: Education sessions tailored to the coding team, focused on areas of improvement identified during the audit.
• Specialized Training: In-depth training on specific coding, abstracting, and query logic, available upon request.
• Debriefing Session: A meeting with your hospital leadership team to discuss audit results and next steps.

At S1 Healthcare, our mission is to empower healthcare providers to enhance coding accuracy, ensure compliance, and optimize financial performance through thorough and strategic auditing services.