E/M level validation
Compare billed levels against documented medical decision making or time, under current E/M guidelines.
Find it before the payer does
Audits that tell you what a payer would find, while you can still fix it.
An audit is only useful if it produces decisions. T Zync reviews coding, documentation and billing behavior against payer policy, quantifies the exposure in both directions, and hands back a corrective plan with owners and dates.
Designed for
Practices facing payer review, staff turnover or unexplained revenue movement
No PHI through public forms
01 What this solves
Undercoding and overcoding are both expensive.
Most practices discover a coding problem through a payer request for records, a recoupment letter or a sudden drop in collections. By then the exposure is already historical and the correction window has narrowed.
A proactive audit answers three questions: are the codes billed supported by the documentation, is the practice leaving supportable revenue on the table, and which patterns would draw payer attention if reviewed.
T Zync reports both directions honestly. Undercoding is identified as clearly as overcoding, because a practice that systematically bills below its documented level is losing money it has already earned.
02 What is included
A review that produces decisions.
Modifier review
Test modifier use, including 25, 59 and the X-series, against payer edits and documentation support.
Diagnosis coding accuracy
Check specificity, sequencing and whether the diagnosis supports medical necessity for the service billed.
Procedure and unit review
Validate CPT and HCPCS selection, units, drug wastage reporting and bundling against NCCI edits.
Documentation sufficiency
Assess whether the note as written would survive an external reviewer reading it cold.
Payer-pattern risk scan
Identify billing distributions that sit outside specialty norms and would attract review.
Financial exposure estimate
Quantify identified over- and under-payment in dollars, not adjectives.
Corrective action plan
Deliver prioritized fixes with owners, sequence and measurable follow-up.
03 What the audit measures
Scope defined before the work starts.
Every engagement fixes its scope in writing so findings are comparable over time.
| Audit element | How it is scoped |
|---|---|
| Sample size | Agreed per provider before the review, sized to the question being asked rather than to a fixed number. |
| Date range | Bounded by the reason for the audit, such as a payer request period, a staffing change or a fiscal year. |
| Reference standard | Current CPT, ICD-10-CM and HCPCS guidance, NCCI edits and the specific payer's published policy for the plan in question. |
| Reporting | Findings by provider and by error type, with financial impact separated into over-billed and under-billed. |
| Follow-up | Re-review of the same error types after the corrective period, to confirm the fix held. |
T Zync performs operational and educational audits. Engagements carried out under attorney-client privilege, or in response to an active government investigation, should be directed to qualified healthcare counsel.
04 How it runs
From sample to sustained correction.
- 01
Define
Agree the question, scope, sample and reference standard in writing.
- 02
Review
Examine claims against documentation and payer policy, coder-reviewed rather than software-scored.
- 03
Report
Deliver findings by provider and error type, with dollar impact in both directions.
- 04
Correct
Implement edits, documentation cues and provider education, then re-test the same error types.
FAQ Audit guidance
Audit questions, answered clearly.
For guidance specific to your specialty, payer mix and systems, speak with T Zync.
How many charts should be audited per provider?
It depends on the purpose. A baseline educational review usually examines a small sample per provider, while a review responding to a payer inquiry or a suspected systemic error needs a larger, statistically defensible sample. Scope is agreed before work begins.
Will an audit report undercoding as well as overcoding?
Yes, and both are quantified. Practices that consistently bill below the documented level of service are losing earned revenue, which is a finding worth as much as any compliance exposure.
What happens if the audit finds overpayments?
Findings are presented with the financial estimate and the options. Decisions about refunds, self-disclosure or repayment are the practice's to make, and significant findings should be reviewed with healthcare counsel before action.
Do you audit our current billing company's work?
Yes. Independent review of an incumbent vendor is a common engagement, and it is scoped and reported the same way as an internal review.
How often should a practice audit?
Many practices run a baseline review annually, with additional reviews after a coding-guideline change, a new provider joining, a new payer contract or a shift in denial patterns.
Is an audit disruptive to the providers?
The review itself is performed from documentation already in the system. Provider time is needed only for the education session at the end, where findings are discussed.
05 Keep exploring
Related revenue-cycle services.
Accuracy at source
Medical Coding
Specialty-aware ICD-10, CPT and HCPCS coding with documentation alignment.
Recover and prevent
Denial Management
Root-cause appeals and prevention rules that stop repeat leakage.
Full operation
Revenue Cycle Management
One connected operation from eligibility to final payment.
Start with clarity