Healthcare Coding and Compliance Audits
Audit insight that strengthens accuracy, compliance, and performance.
Healthcare Coding and Compliance Audit Insight
Healthcare coding and compliance audits provide clarity in complex regulatory environments by revealing where processes are working, where risk exists, and where improvement is needed. UASI conducts structured audits that help organizations identify compliance gaps, validate accuracy, and gain actionable insight across coding, billing, documentation, and regulatory oversight.
High-performing organizations treat audits as intelligence, not setbacks. Findings create opportunities to strengthen controls, refine workflows, and prevent issues before they escalate into denials, penalties, or revenue loss. Audit insight also supports workforce effectiveness by clarifying expectations, reinforcing consistency, and helping coding, CDI, and billing teams perform with greater confidence.
Specialty Audit Reviews
Specialty audit reviews address focused compliance and performance risks while also validating whether teams are equipped with the knowledge, tools, and workflows required to manage high-impact scenarios effectively.
- Ambulance and EMS Coding & Compliance Audits: Targeted medical coding audits focused on ambulance and EMS encounters, including CMS requirements, medical necessity validation, and documentation accuracy to support compliant reimbursement.
- Forensic Audit Reviews: In-depth medical record audits that examine billing and coding activity to identify root causes of revenue leakage, compliance exposure, and process breakdowns.
- Catastrophic Case Reviews: Detailed medical chart audits for high-acuity and catastrophic cases to ensure complete documentation, appropriate code assignment, and defensible billing.
- CDI Program Effectiveness Reviews: Structured reviews that assess documentation quality, query practices, and alignment between CDI, coding, and quality initiatives.
- Pre-Bill Second-Level Reviews: An additional layer of audit review prior to claim submission to validate documentation support and coding accuracy before billing.
Coding Accuracy and Compliance Audits
Coding audits provide objective insight into how codes are assigned, supported, and applied across clinical and financial workflows. In addition to identifying compliance and accuracy trends, these audits help organizations understand where coding teams are performing consistently and where clarification or reinforcement can strengthen reliability and confidence.
- Diagnosis and Procedure Code Validation: Medical coding audits that review ICD-10-CM, ICD-10-PCS, and CPT code assignment for accuracy, consistency, and regulatory alignment.
- Coder Performance Evaluation: Independent reviews that assess coding accuracy trends and identify opportunities for improvement without disrupting operations.
- Risk-Focused Compliance Reviews: Targeted audits that concentrate on high-risk services, payer rules, and compliance-sensitive areas to reduce exposure and support audit readiness.
HCC and Risk Adjustment Audits
Risk adjustment accuracy plays a critical role in Medicare Advantage oversight and regulatory compliance. HCC-focused audits help organizations evaluate documentation and coding practices that impact risk scores and audit exposure.
- Health Record Reviews: Medical record audits that identify coding gaps, unsupported conditions, and documentation deficiencies affecting HCC capture.
- Improvement Guidance: Practical recommendations to strengthen documentation integrity, coding accuracy, and internal oversight.
This work supports organizations preparing for Medicare Advantage audits, RADV audits, and CMS RADV audits, while also clarifying expectations for internal teams operating in highly scrutinized risk adjustment environments.
Inpatient and Outpatient CDI Audits
CDI audits evaluate how clinical documentation supports accurate coding, quality reporting, and compliant billing across care settings.
- Comprehensive Record Reviews: Medical chart audits of inpatient and outpatient encounters to assess documentation completeness and clinical clarity.
- Opportunities and Recommendations: Identification of documentation gaps and actionable recommendations that support sustainable improvement.
- Education and Knowledge Transfer: Audit-driven education that reinforces documentation standards, clarifies clinical expectations, and strengthens long-term performance.
Medical Billing and Regulatory Audit Readiness
Medical billing audits provide visibility into how claims are constructed, supported, and submitted across payer programs. These audits help organizations evaluate billing accuracy and prepare for increasing regulatory scrutiny.
Clear audit insight allows billing teams to better understand how documentation support, payer-specific rules, and internal workflows influence accuracy, consistency, and confidence.
Audit experience includes:
- Medical billing audit and medical billing auditing reviews
- Medicaid audits and compliance assessments
- Medicare Advantage audits
- RADV audits and CMS RADV audit preparation
By identifying issues early, organizations gain the ability to address gaps proactively rather than reactively—reducing risk while strengthening governance, internal controls, and departmental effectiveness.
Using Audits as Strategic Intelligence
The strongest organizations understand that audits are not about what went wrong, they are about what can be improved. Audit findings provide insight that can be acted on before issues become crises or revenue drains.
Organizations that use audits strategically refine processes, strengthen controls, and build systems that support consistent performance. Audit clarity also reinforces role understanding, reduces ambiguity, and enables teams to operate with greater confidence and accountability.
Healthcare coding and compliance audits create the visibility required to make informed decisions, improve performance, and move forward with confidence..
Frequently Asked Questions
What is a healthcare coding and compliance audit?
A healthcare coding and compliance audit reviews medical records, coding, billing, and documentation to assess accuracy, regulatory alignment, and compliance risk.
How do medical coding audits and medical billing audits differ?
Medical coding audits evaluate code accuracy and documentation support, while medical billing audits focus on claim construction, submission, and payer compliance.
What can a medical record or medical chart audit uncover?
These audits identify documentation gaps, unsupported codes, compliance risk, and workflow inconsistencies that may affect reimbursement or audit exposure.
How do audits support Medicare Advantage and RADV readiness?
Healthcare coding and compliance audits help validate risk adjustment accuracy and documentation support for Medicare Advantage audits, RADV audits, and CMS RADV audits.
Are audits only focused on compliance issues?
No. Audits also provide operational insight, helping organizations improve consistency, clarify expectations, and strengthen departmental performance.
How do audits support Medicaid audits?
Medical billing auditing and compliance reviews help organizations evaluate alignment with Medicaid requirements and reduce regulatory risk.
