Medical Record Auditing

Maintaining Quality Control in Medical Record Audits

Does your organization conduct medical record auditing? Healthcare Resolution Services (HCRS) has extensive experience and a strong record of success in RAC (Recovery Audit Contractor) Audits and Audit MICs (Medicaid Integrity Contractors), working with all medical specialties. If you need help with your medical record auditing, HCRS is the company to go to. Our experienced medical record auditors are ready to help you ensure your organization is running at its optimal level. Learn more about our medical record auditing services and see how we can help your organization reach new heights!

Benefits of Medical Record Auditing

If you don’t currently conduct medical record auditing in your healthcare organization, consider its many benefits and see whether it will make a difference for you (we’re betting it will!). Medical record auditing can help you:

Improve service for your customers
Reduce errors
See where to increase/decrease costs
Ensure quality of employee work
Improve overall medical records system
And more!

Medical record auditing with a health information management company like HCRS can help you run your organization more smoothly and continue to improve your services. Medical record auditing will benefit your organizations in more ways than you’d think!

Experienced Medical Record Auditing

All of our medical records auditors are AHIMA- or AAPC-certified coder auditors with at least five years of experience, committed to providing superior data integrity. HCRS employs outstanding auditing professionals, including Nurse Auditors/Coders, who operate under diligent physician oversight. Performance audits are conducted quarterly and annually to determine whether auditors are accurately performing all reviews and other required functions. Based on these audits, HCRS establishes an overall medical records audit performance rating for each auditor. So you can feel confident you are getting an expert auditor who will help you gain the most from your medical records audit.

To maintain or improve long-term audit performance, HCRS also creates training templates for auditors based on a comprehensive review of medical records audit results. This enables us to design targeted training courses customized to fit a customer’s actual audit results.

Our Medical Record Auditing Process

Our medical record auditing process focuses on the most vulnerable types of claims. This way, your business will gain the most benefit from auditing your medical records. We will focus on the following types of claims:

Incorrect payment amounts
Non-covered services, including those services deemed medically unnecessary
Miscoded claims
Duplicate claims

To further ensure quality, we follow a three-level review process as part of our medical record auditing service. This will ensure your medical records audit is completed correctly so you can gain as much from it as possible. For all medical records audits, our experienced auditors will go through the following three quality control checkpoints:

First-level review (individual medical record audit review) performed by the Coding Auditors on their coding reviews at the end of each audit project
Second-level review performed by Senior Coding Auditors who review a random three-percent sample of the Coding Auditors reviews
Third-level review performed by the Peer Review Analyst who conducts a random three-percent review of all auditors’ work