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Audx-C

Audx-C is our proprietary system to review claims to ensure correct billing and coding standards using a combinataion of industry-standard rules for medical billing including

NCCI

 

National Correct Coding Initiative

NUBS

 

National Uniform Billing Standards

MUE

 

Medically Unlikely Edits

LCD

 

Local Coverage Determination

PTP

Procedure to Procedure

NCD

 

National Coverage Determination

Audit Considerations
Other Industry Standard Audits
Audxguard
Upcoding
Unbundling
Physician Review
Medical Appropriateness
Itemized Bill Review on Select Claims
Egregious Overbilling
Duplicate Payments
Client Average Discount
Ambulance - Charge Review
Adjudication Reimbursements

Key Stages

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Final Deliverable

Final Audit Report will contain information pertaining to but not limited to:

01

Document Language 

Dedicated documentation of any language that may put the plan in noncompliance with the CAA that was found in the SPD or Provider agreements with clear description of what needs to be altered.

03

Datasets

The report will provide cascading levels of detail of results on various audit triggers. There will also owe facility reports included that show the frequencies  and patterns of billing for certain triggers to inform plan steerage

02

Opinion and Rationale

Overall impression obtained from the audit in summary fashion and detailled rationale with supporting graphs and charts underpinning the causation of any discrepancies found.

04

Conclusion and Next Steps

Here there will be a final recapitulation of the data analysis along with information on how to pursue recovery if the plan chooses to do so. 

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