“AuditGuard provides unparalleled support in the coding and documentation function for hospitals that operate physician practices. In addition to mitigating exposure to RAC audits, we estimate that our net revenue will increase by 5-6%…providing a return on investment for a service that we initially thought was simply a necessary cost of doing business.”

— Steven Heatherly, Chief Financial Officer, WestCare Health System


Major areas of audit vulnerability for physician practicesinclude inaccurate coding, incorrect payment amounts, inadequate documentation, non-covered services, lack of documented medical necessity, bundling and/or unbundling of services, and utilization of modifiers.

AuditGuard® will teach your providers and staff how to overcome and eliminate such areas of vulnerability, while simultaneously helping you increase revenues by maximizing legitimate reimbursement, achieving optimum levels of compliance and improving profitability. In fact, after six months with AuditGuard®, our average client enjoy a coding and billing accuracy rate in excess of 96% and an increase in legitimate reimbursement of between 5% and 7%.


How can AuditGuard® enhance my revenues?

With AuditGuard® your providers and staff will learn how to document, capture changes and code and bill with unerring precision. We will materially enhance the skill sets of your staff, hone your charge capture mechanism, keep you current with every change and nuance in coding and billing requirements, and insure that you are always realizing maximum legitimate reimbursement. Through the AuditGuard® “Ask the Expert” service our senior level coding, billing and compliance professionals are virtually on your staff—immediately available to answer questions and problem solve with your providers and staff. Within twelve months of implementing AuditGuard® the average client reports an increase in net revenue between 5% and 7%

How does AuditGuard® affect billing performance?

Your AuditGuard® team will work with your staff on an ongoing basis to optimize billing performance and achieve unparalleled levels of compliance. We will develop a customized, ongoing billing audit protocol for your practice that will identify compliance vulnerabilities as well as areas in which maximum revenues are not being realized. Using the audit results as our road map, we will develop and implement an ongoing staff development program that will increase the skill sets of your employees, eliminate compliance vulnerabilities and ultimately improve billing performance—and better billing performance equates to better cash flow, higher collections and improved operating results.

What types of billing issues are most prevalent?

Inaccurate coding, incorrect payment amounts, inadequate documentation, non-covered services, lack of documented medical necessity, bundling and/or unbundling of services, ICD/CPT linkage, utilization of modifiers and the disposition of pended and denied claims are areas in which AuditGuard® typically facilitates improvement in billing performance.

If I have an under-coding problem can I go back and recover past under-payments?

Yes, but unless there are material amounts of reimbursement at stake, we typically do not suggest submitting large numbers of amended claims. In the current environment, submission of the amended claims would very likely trigger an audit.

Do you really see 60% coding error rates?

Actually, the average coding error rate we have documented over the past twenty years is 58%—and that is based on over 4,000 physician audits. For practices with an EMR/EHR, the coding error rate is only marginally better at 54%. Many people believe that EMRs/EHRs are a panacea for documentation and coding problems, but nothing could be further from the truth. Please note that the aforementioned coding error rates include both under- and over-coding. And remember, coding requirements and billing regulations are constantly changing—that is the main reason error rates are so high and why AuditGuard® makes a multi-year commitment to excellence in your practice.