Coding and Billing Audits

TD&P’s Coding and Billing Audit is a process that evaluates the reliability of clinical documentation provided during the discovery phase of litigation. We thoroughly review health records offered by providers on behalf of plaintiffs and assess the submitted medical billing data. This ensures that the providers offer reliable records that both plaintiff and defense counsels can rely on and that the referenced treatments meet Evidence-Based Medicine Standards. 

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 ledger, as required. 

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. 

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. 

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 and defense counsels. 

Medical Billing Audits assist the litigation team in confirming the accuracy of claims presented by plaintiffs 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. 

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.