Mandated Medical Coding Audit Assistance
Navigate the complexity of mandated audits and get your organization back on track
Mandated medical coding audits should not be taken lightly as it may result in serious financial and legal impact on your organization. These audits include TPE, RAC, Payment Integrity, OIG Recoupment, NCCI Edits, Medical Necessity, and more. It is critical to choose the right auditor who will work with your team to identify the trouble areas, create an actionable correction plan, and get your team back on the right track.
STAR’s team of exceptional HIM & Clinical professionals have experience working on mandated audits not only with healthcare providers, but also with insurance payors, Medicare Administrative Contractors (MACs), utilization management companies, and more. Our team has deep understanding on how different mandated audits work and how to best navigate them.
Is your organization at risk for a TPE Audit?
CMS has resumed its Medicare Targeted Probe and Educate (TPE) program after suspending it during the pandemic. Healthcare organizations with high claim error rates or unusual billing practices are at high risk to be selected for an unannounced TPE audit, especially those that provide services with high national error rates.
STAR can help your organization mitigate the risk of having a TPE audit and be prepared for one should it occurs
Our team of HIM & CDI professionals can help your organization mitigate the risks of being a target of a TPE Audit by conducting an audit of your documentation and coding practices, identifying any areas of concerns or potential non-compliance, and addressing them with education and guidance before a mandated TPE audit occurs.
Top risks a TPE audit pose to your organization:
Unannounced audit by CMS compromises staffing
Risk of off-cycle revalidation for Medicare billing
High risk of Recovery Auditor Contractor (RAC) referrals
Impedes patient care through strained utilization of staff
Jeopardizes timely billing through mandatory prepayment reviews
Suspension of Medicare billing and payments
Ultimate exclusion from Medicare billing privileges