Their reviews aligned 89% of the time and identified only 46% of claims with issues, half of which were related to medical necessity, not coding errors. “These audits are very intricate work that take ...

Coding experts agree that ASCs should conduct regular audits of their coding processes to ensure the ASC is not upcoding, a possible fraud issue, or downcoding, leading to a loss of owed reimbursement ...

Hospitals and clinics are preparing for a high-stakes 2026 as CMS coding updates, payer-specific rules, and AI-powered audits converge to increase compliance risks. New telehealth, chronic condition, ...

ASCs should incorporate an external audit into their compliance programs. Formal coding audit protocol should define the purpose of the audit, frequency of review and sample size. The difficult part ...