Medical Coding Audits
Coding Audit Services
SunHawk’s team of certified medical coding and audit experts possess knowledge across a wide range of specialties and have assisted dozens of organizations in improving their medical coding programs. Additionally, SunHawk Professionals have decades of experience preparing for and responding to external medical coding audits conducted by government agencies or health insurers.
How We Can Help:
- Medical Coding / Documentation Audits: We assess whether a provider’s level of service is supported by coding guidelines, specify recommendations to improve accuracy and compliance, and provide feedback on potentially high-risk documentation concerns.
- RAC & External Audits: We provide end-to-end support to ensure your organization is well-prepared for RAC and other external audits. Our team of experts will help you identify potential vulnerabilities, implement proactive measures, and effectively respond to audit inquiries. We ensure your positions and your needs on complex issues and subjects are clearly communicated to government regulators and enforcement personnel.
Provider & Staff Coding Education
Increasing physician coding proficiency can materially impact your organization’s bottom line and lower your regulatory risk. SunHawk’s education program takes a holistic approach to help any team boost its knowledge and improve and/or reinforce coding competency. We work with a wide range of entities, including major hospital groups, SNFs, Cancer Centers, dental practices, as well as small, independently owned physician practices.
Credential and Licenses Held by Our Experts Include:
- Certified coders (CPC, CCS, RHIA, RHIT, etc.)
- Certified Risk Adjustment Coder (CRC)
- Advanced Hierarchical Condition Category Associates (AHCCA)
- Healthcare Anti-Fraud Associates (HCAFA)
- Licensed Nurses and Nurse/Coders
- Licensed Physicians
Illustrative Projects and Assignments:
- Medical coding reviews: both inpatient and outpatient settings
- Medical coding and documentation audits
- Clinical documentation improvement reviews
- Documentation of Medical Necessity Interventions
- Quarterly coding quality control reviews
- Review of coding related to issues of fraud, waste, or abuse (FWA)
- Development of risk adjustment and coding policies
- Responding to law enforcement reviews and findings related to medical coding
- Risk Adjustment coding
- Educating coders and clinicians on risk adjustment coding requirements and standards
- Statistical overpayment estimation and reporting
- Quarterly monitoring of claims and billing quality
Testimonials
Get In Touch
SunHawk Consulting
2550 E Rose Garden Ln.
Unit 72016
Phoenix, AZ 85050
[email protected]
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