5 Signs Your Medical Coding Team Needs an Audit Right Now
When it comes to healthcare revenue cycle management, coding accuracy isn’t just important—it’s everything. Accurate coding drives reimbursement, reduces compliance risk, and ensures that patient encounters are properly documented. But even high-performing teams can fall into blind spots. If you're noticing any of the following signs, it's time to hit pause and conduct a medical coding audit.
1. A Sudden Spike in Denials
If denial rates are climbing and you’re not sure why, the issue could lie in your coding. Modifier misuse, missing documentation, or incorrect diagnosis codes are common culprits. An audit can help uncover root causes and pinpoint exactly where breakdowns are happening.
2. Inconsistent Use of Modifiers
Modifiers -25 and -59 are two of the most commonly misused, leading to denials and compliance risk. If your team is unclear on when and how to apply modifiers, or if you're seeing inconsistent application across providers, it's a red flag that calls for immediate review.
3. You’re Preparing for a Payer or OIG Audit
If you know an external review is coming, don’t wait to find out what they’ll uncover. Conducting a proactive internal audit helps you catch errors, fix documentation gaps, and present stronger data. It’s also a sign of a mature compliance program.
4. Heavy Reliance on Manual or Siloed Processes
Still using spreadsheets or outdated systems to manage reviews? This not only slows down your team but increases the likelihood of human error. Coding audits reveal where your processes need improvement—and which tools could help.
5. Declining Reimbursement Without Clear Cause
If collections are down but visit volume is stable, it could be a coding issue. Undercoding, missed charge opportunities, and incorrect sequencing can all quietly erode revenue. Audits can help you uncover the story behind the numbers.
Audit Smarter with the Right Tools
Conducting an audit isn’t just about finding mistakes—it’s about uncovering opportunities. With tools like MRSAuditQ, teams can automate chart selection, score documentation in real-time, and provide clear, data-driven feedback to coders and providers.
Ready to find out what’s really happening behind your claims?
Let us help you strengthen your coding operations and build a smarter revenue cycle.
Visit www.mrsnh.com or reach out to robin@mrsh.com to schedule your internal audit today.
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