Coding and Billing Audits

Ensuring Reliable Clinical Documentation and Medical Billing

At TD&P, our Coding and Billing Audit process evaluates the reliability of clinical documentation provided during the discovery phase of litigation. We thoroughly review health records offered by providers and assess the submitted medical billing data. This ensures that the records are reliable and that the referenced treatments meet Evidence-Based Medicine Standards. Our services are available to both plaintiffs and defendants, including hospitals and insurance companies.

Comprehensive Record Collection

During a Coding and Billing Audit, TD&P’s team collects clinical records such as medical records, x-rays, and lab reports, along with financial records, including entered charges, explanation of benefits (EOBs), and accounts receivable ledgers, as required.

Benefits Throughout the Discovery Phase

Coding and Billing Audits can be conducted at any time during the discovery phase and are beneficial for litigators to ensure the medical necessity of identified or received care.

Thorough Medical Billing Audits

Medical Billing Audits cover various aspects of the billing life cycle, including:

• Insurance verification processes
• ICD-10-CM and CPT coding
• Claim submission
• Payment posting
• Follow-up and denial management processes

Identifying and Addressing Coding Problems

Billing Audits help identify coding problems during litigation or before challenges from the government or insurance payors. TD&P’s audits are crucial for identifying inaccuracies that affect proper reimbursement. Our audit team safeguards the value of cases for plaintiffs, defense counsels, hospitals, and insurance companies.

Enhancing Litigation Strategy

Medical Billing Audits assist the litigation team in confirming the accuracy of claims and ensuring proper presentation to counsel. Audits help avoid unnecessary frustrations and identify improper unbundling and coding practices early in the discovery process. TD&P auditors protect the viability of cases long before they go before a jury.

Uncovering Fraudulent Activity and Reimbursement Deficiencies

Through audits, counsels can identify fraudulent billing activity and claims, as well as discover reimbursement deficiencies and deviations from industry standards in the treatment of medical conditions that may impact their case.

If you would like to learn more about our Coding and Billing Audit services or have any questions, please feel free to reach out to us at (240) 670-7982 to speak with a member of our team.