What is Medical Auditing

What is medical auditing?

Medical auditing is a thorough assessment of coding and billing information to validate accuracy and compliance within a healthcare organization. Most audits look at components of payer reimbursement processes to evaluate compliance with payer guidelines as well as federal and state regulations. The medical audit serves a vital role in a healthcare organization to ensure both risk mitigation and quality revenue cycle management.

What are the different types of medical audits?

There are two primary types of HIM medical audits. External audits identify compliance issues and areas in which to improve performance. External audits also determine education needs within an organization. Internal audits identify areas of weakness within the coding and billing staff so that focused education can be provided.

What are the benefits of a medical audit?

  • Identify errors in coding and billing, including under coding, upcoding, unbundling, and incorrect use of modifiers.
  • Identify fraudulent billing practices, both intentional and nonintentional
  • To establish an effective quality assurance process to onboard new coders and providers
  • To identify and provide focused education on missed opportunities and other areas of strengths and weaknesses
  • To address areas of risk to prevent Risk Audit Contractor (RAC) or Risk Adjustment Data Validation (RADV) investigations
  • To improve patient quality of care and help improve safety measures

Does Intellis hire medical auditors?

Yes! See our open positions here.

Does Intellis offer medical auditing services?

Yes! Check out Intellis IQ medical auditing services.
Intellis offers HIM and revenue cycle services. Please see our suite of Health Information Management Services and Revenue Cycle Solutions.

Intellis offers AHIMA-approved CEUs.

The Intellis IQ Education Center offers coding and clinical documentation continuing education approved by AHIMA. Please contact us if you have questions about our education platform and how it helps individuals and organizations.