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ChartLevel Review
50States
Billing and Coding Audit Services
A billing and coding audit is a scoped review of coded claims against documentation, fee schedules, and payer payments — what was undercoded, what was denied for a repeat reason, and what the contract actually allows. Vector Medical Billing runs that retrospective read as a separate engagement from Jamaica, NY, for practices in all 50 states.
Separate engagement
What a billing and coding audit is
It is not day-to-day coding production. It is a defined sample of charts and claims reviewed for accuracy, compliance risk, and payment alignment.
Ongoing medical coding assigns codes as visits happen. An audit steps back: does the documentation support the CPT, ICD-10, HCPCS, and modifiers that went out — and did payment match what the fee schedule or contract allows?
On Vector’s services list this is a separate engagement — scoped and priced before kickoff, not a silent add-on on the monthly billing percentage.
Audit types we scope
The engagement states sample size, providers, date range, and whether findings are for patterns only or a wider estimate.
Retrospective
Already submitted or paid claims re-read against documentation and remittances. Vector’s published audit description centers on this retrospective view — undercoding, repeat denial reasons, and contract allowed amounts.
Pre-bill (prospective)
Charts reviewed before submission — useful for new providers, EHR changes, or after a compliance finding. Errors are fixed before they become denials or overpayments.
Focused / targeted
One risk area — for example E/M level mix, modifier 25/59, surgical bundling, or a specialty’s high-denial codes — when the full book does not need a blanket sample.
What the review covers
Exact code sets and specialties are written into the scope. Typical physician-practice audits look at the areas below.
| Area | What we test | Why it matters |
|---|---|---|
| CPT / HCPCS / modifiers | Code and modifier match to documentation | Undercoding leaves money; overcoding and bad modifiers create denials and compliance risk |
| ICD-10-CM linkage | Diagnosis specificity and support for the service | Medical necessity and clean claim edits depend on linkage |
| E/M leveling | MDM or time support for the billed level | Common pattern finding in outpatient books |
| Bundling / NCCI logic | Pairs, units, and add-on rules | Repeat denial codes often start here |
| Fee schedule vs paid | Allowed / contracted amount vs remittance | Shows gaps that may need underpayment work — not assumed as coding error |
| Denial patterns | Repeat CARCs on the sample | Feeds process fixes and, separately, denial management |
A pattern-finding sample is not automatically a license to extrapolate dollars across every claim you billed. If a population estimate is required, that sample design is stated in the written scope.
How the engagement runs
Scope first. Then charts, findings, and a remediation path the practice can own.
1
Scope
Providers, date range, audit type, sample size, and whether findings stay pattern-only.
2
Pull charts
Documentation, claim lines, and remittances for the agreed sample inside your EHR.
3
Score
Line-level findings: supported code, suggested correction, and reason grouped by root cause.
4
Report & educate
Written findings, priority fixes, and optional re-audit after changes land.
What a finding line looks like
Illustrative composite — not a client result and not an extrapolated recovery amount.
| Field | Example entry |
|---|---|
| Encounter | Established office visit; billed 99214 |
| Documentation | MDM supports straightforward / low — closer to 99213 on review |
| Finding | Possible overcoding risk on E/M level for this chart |
| Remittance check | Paid at billed level; no denial — compliance pattern, not a short-pay |
| Recommendation | Provider education on MDM elements; spot re-audit in 60 days |
We do not publish a Vector “accuracy rate” or blanket recovery percentage from audits on this page without a scoped engagement and documented sample method.
What this audit is not
Related services stay separate so the quote matches the work.
Not ongoing coding
Production coding sits under medical coding services. The audit samples and scores; it does not replace daily charge coding unless separately scoped.
Not underpayment recovery alone
Contract short-pays found in the remittance review may point to underpayment recovery. That chase is its own engagement.
Not the free contact review
The free billing conversation on contact is a high-level look. A formal chart-level audit is quoted with sample size and deliverables in writing.
How the audit is priced
Billing and coding audits are quoted as a separate engagement — typically fixed by scope (providers, sample size, retrospective vs pre-bill, specialty focus). Contingency fees tied to “upcoding found” create the wrong incentive; Vector’s audit work is scoped up front.
Ask for a written scope. Do not assume the monthly billing percentage includes a formal chart audit.
What we need to start
EHR access or chart export for the sample window, claim and remittance detail for those encounters, and specialty context so the review uses the right rules.
Codes, documentation, and payments checked in one sample
Tell us specialty, providers, and whether you need retrospective, pre-bill, or focused work. We reply with a written sample plan and fee — without inventing an accuracy percentage for your book.
Sample
Scoped Charts
Code
+ Payment View
Separate
Engagement
50
US States
Billing and coding audit questions
Straight answers tied to the sections above.
What is a billing and coding audit?
A scoped review of coded claims against documentation — and, in Vector’s model, against fee schedules and payer payments — to find undercoding, overcoding, modifier issues, and payment gaps.
Is it the same as medical coding services?
No. Coding services assign codes for current work. An audit samples finished charts and scores them. Both can be in place; they are different engagements.
Do you only look at codes?
No. Vector’s published audit description also reads fee schedules and payer payments — including what the contract allows versus what posted.
Will you extrapolate a dollar recovery from the sample?
Only if the written scope says the sample is designed for that. Pattern-finding samples report findings without inventing a practice-wide recovery figure.
Is the audit included in monthly billing?
No by default. It is a separate engagement unless your written contract explicitly includes it.
Do we change our EHR?
No. Reviews run against charts and claims in the system you already use, confirmed before start.