Data Quality Auditing
At Gust RCM, our comprehensive auditing services go beyond coding accuracy to evaluate the complete integrity of the medical record, clinical documentation, and coded data.
We provide both pre-bill and retrospective audits designed to identify compliance risks, reimbursement opportunities, documentation deficiencies, and process improvement initiatives before they impact your organization. Our audit team reviews physician and facility services across all patient types and care settings, including inpatient, outpatient, emergency department, ambulatory surgery, observation, and professional services. Using experienced, credentialed auditors, we assess the accuracy, completeness, and consistency of coded data while ensuring compliance with official coding guidelines and payer requirements.
Comprehensive Audit Scope
Our audits examine far more than code assignment alone. Reviews may include:
ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding accuracy
Clinical documentation completeness and specificity
Medical necessity validation
Present on Admission (POA) indicator accuracy
Severity of Illness (SOI) and Risk of Mortality (ROM) impact
Diagnosis Related Group (DRG) validation
Query opportunity identification
Social Determinants of Health (SDOH) coding opportunities
Principal and secondary diagnosis selection
Procedure code assignment and sequencing
Charge capture review
Quality measure documentation impacts
Compliance and regulatory risk assessment
Denial prevention opportunities
Revenue optimization opportunities
Post Audit Education
At Gust RCM, our auditing services provide healthcare organizations with a clear understanding of coding quality, documentation integrity, compliance performance, and revenue opportunities, helping leaders make informed decisions that strengthen financial and operational outcomes.
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