Coding & Compliance Audits

Find Coding Issues Before They Become Bigger Problems.

Accurate coding is important. But accuracy is only one part of a strong healthcare billing and compliance process. Coding errors, incomplete documentation, inconsistent billing practices, inappropriate code selection, and other issues can create financial risk, increase denials, and expose healthcare organizations to unnecessary compliance concerns.

A Strong Revenue Cycle Starts With Accurate and Responsible Coding.

Know What's Happening Behind Your Claims

Healthcare organizations process large volumes of encounters, claims, and clinical documentation. Even with experienced teams, inconsistencies can occur. A coding audit provides an opportunity to step back from daily operations and examine whether coding and documentation practices are aligned with applicable requirements and organizational policies.

DuoSol helps organizations conduct focused reviews that turn findings into practical improvement opportunities.

Identify Coding Issues

We review selected encounters to identify potential coding errors, inconsistencies, and areas requiring additional attention.

Review Documentation Support

We assess whether available documentation supports the coding and billing information being reviewed.

Identify Compliance Risks

We help identify potential areas of compliance concern based on the scope and criteria of the audit.

Strengthen Internal Processes

Audit findings can provide useful insight into where training, documentation, coding, or workflow improvements may be needed.

What We Audit

Comprehensive Coding & Compliance Audit Support

The scope of an audit can be customized according to your organization’s goals, specialty, payer mix, and risk areas.

Diagnosis Coding Review

We review diagnosis coding against the available clinical documentation and applicable coding requirements.

Procedure Coding Review

We examine procedure and service coding to determine whether the codes appropriately reflect the documentation reviewed.

CPT & ICD-10 Review

We support focused reviews of CPT and ICD-10 coding for accuracy, consistency, and appropriate documentation support.

HCPCS Review

Where applicable, we review HCPCS coding for services, supplies, and other billable items.

Modifier Review

We examine modifier usage to identify potential inconsistencies or areas that may require additional review.

Documentation Review

We review available clinical documentation to determine whether it supports the coding and billing information under review.

Medical Necessity Review

Where included within the audit scope, we review documentation and coding against applicable medical-necessity criteria and payer requirements.

E&M Coding Review

For applicable services, we review evaluation and management coding against the documentation available.

Bundling & Unbundling Review

We identify potential coding patterns that may require additional review, including concerns related to bundled services.

Our Coding & Compliance Audit Process

A Structured Review From Sample Selection to Actionable Findings

An effective audit should do more than identify errors.It should help your organization understand the findings and determine what should happen next.

01

Define the Audit Scope

We work within the agreed scope to determine the services, specialties, providers, time period, payers, or risk areas included in the review.

02

Select the Sample

A representative or targeted sample is selected based on the objectives and methodology of the audit.

03

Review Documentation

We examine the available clinical and billing documentation relevant to the selected encounters.

04

Evaluate Coding

Diagnosis, procedure, modifier, E&M, and other applicable coding elements are reviewed against the documentation and defined audit criteria.

05

Identify Findings

Potential coding, documentation, billing, and compliance-related issues are documented and categorized.

06

Determine Patterns

We look beyond individual errors to identify recurring trends that may indicate a broader process or training issue.

Why DuoSol?

We Look at the Details Without Losing Sight of the Bigger Picture.

A coding audit should not be treated as a simple checklist. The most useful audits connect individual findings to the larger revenue cycle and operational environment.DuoSol takes that approach.

Structured Audit Methodology

We use a defined audit process based on the agreed scope and review criteria.

Documentation-Focused Review

We consider the relationship between the medical record, coding, and billing information.

Objective Findings

Audit results are documented based on the information reviewed rather than assumptions.

Practical Insights

The goal is to give your organization findings that can support meaningful improvements.

Revenue Cycle Perspective

Coding and compliance issues can affect claims, denials, A/R, reimbursement, and overall financial performance.

Frequently Asked Questions

Answers to Common Questions

Everything you need to know about working with DuoSol. Still have questions? Book a consultation and we’ll walk you through it.

What is a Coding & Compliance Audit?

A Coding & Compliance Audit is a structured review of selected healthcare encounters, coding, documentation, and billing practices to identify potential errors, inconsistencies, risks, and opportunities for improvement.

Why should a healthcare organization conduct coding audits?

Regular or targeted audits can help organizations identify coding and documentation issues, support education, monitor internal processes, and identify potential compliance concerns before they become larger problems.

What does a coding audit review?

Depending on the scope, an audit may review diagnosis codes, procedure codes, CPT, ICD-10, HCPCS, modifiers, E&M coding, documentation, medical necessity, billing practices, and other relevant areas.

Do you audit medical records?

We can review the clinical documentation made available within the agreed audit scope to assess whether it supports the coding and billing information being reviewed.

Do you perform E&M audits?

Yes. E&M coding can be included when applicable to the services and scope of the audit.

Can you identify upcoding?

We can identify potential discrepancies between the documentation reviewed and the reported coding, including situations that may warrant additional review for possible upcoding or downcoding.

Do you review modifiers?

Yes. Modifier usage can be included in the audit to identify potential inconsistencies or documentation concerns.

Find Issues. Reduce Risk. Improve Your Process.

Know Where Your Coding Process Stands.

You don’t have to wait for a major denial trend, payer audit, or revenue problem to discover that something needs attention. A proactive Coding & Compliance Audit can give your organization a clearer view of its coding, documentation, and billing practices. DuoSol helps healthcare organizations identify potential issues, understand recurring patterns, and turn audit findings into practical opportunities for improvement.