Ensuring Accuracy, Integrity & Regulatory Adherence in Every Code
We believe that compliance isn’t just a checkpoint—it’s a strategic asset. Our Coding Compliance Audit Services help healthcare organizations elevate coding accuracy, protect against revenue loss, and reduce regulatory exposure by ensuring full alignment with the latest CMS rules, payer policies, and specialty-specific standards.
We provide an independent, detail-focused assessment of your coding practices and documentation integrity—empowering your team to operate with confidence, consistency, and full compliance.
🔍 What We Deliver
🔐 Core Features
|
Feature |
Description |
|
95%+ Accuracy Benchmarks |
Our audits maintain national best-practice thresholds and identify variances to improve accuracy trends. |
|
HIPAA-Compliant |
Every record is handled in accordance with HIPAA and HITECH, with full traceability and role-based access. |
|
Error |
Our reports classify errors (under-coding, over-coding, mismatches) and offer actionable recommendations. |
|
Training |
Coders receive individualized reports and education modules based on audit findings, promoting growth and reduced rework. |
|
Audit Readiness Support |
We provide documentation and insights to support internal reviews, payer audits, or CMS contractor investigations. |
💡 Our Benchmarks
A coding compliance audit is a detailed review of coded medical records to assess accuracy, adherence to CMS and payer guidelines, and documentation completeness. It helps organizations reduce audit risk, avoid revenue leakage, and maintain regulatory credibility.
We follow a structured QA framework with benchmark targets of 95%+ accuracy, and use multi-tiered review methods that evaluate codes, modifiers, and documentation links against national standards and client-specific protocols.
Yes. We offer retrospective, concurrent, and real-time audits based on your workflow preferences—covering both volume-driven chart reviews and targeted specialty audits.
Absolutely. We assess coding and documentation defensibility, identify patterns that could trigger payer reviews, and provide audit-ready documentation and remediation guidance to support compliance.
Yes. Our HCC audit specialists verify diagnosis capture for RAF score accuracy, condition hierarchy validation, and proper chronic condition support under Medicare Advantage and ACA guidelines.
We conduct coder-specific feedback sessions, deliver monthly performance dashboards, and offer training interventions based on audit outcomes to help your staff improve both accuracy and efficiency.
Have questions about our services or how we work? We’ve compiled answers to the most common queries to help you better understand what Spy Health offers and how we can support your healthcare organization. Whether you’re new to medical coding and RCM or looking to switch providers, our FAQs are here to guide you.
+1(978) 502-4707
sales@spyhealthrcm.com
Accurate. Compliant. Certified.
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Healthcare organizations often grapple with administrative stress caused by outstanding claims and
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Denial management services serve as an indispensable pillar in upholding the
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Partner with Spy Health for expert medical coding and revenue cycle management solutions. Our team is here to support your growth with precision and reliability.
Spy Health’s team of over 800 AAPC & AHIMA-certified medical coders precisely assign accurate codes to ensure regulatory compliance and facilitate timely, appropriate reimbursement.
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