Uncover Hidden Revenue Leaks and Bulletproof Your Practice Against Audits.
Our senior AAPC-certified forensic auditors evaluate clinical documentation, modifier usage, and fee schedule alignment to pinpoint systematic under-coding, halt RAC clawbacks, and recapture 15–20% in earned clinical yield.
High-frequency 99213 down-coding identified when 99214 was fully supported by complexity & MDM.
CPT 99214 + -25 billed with minor procedures missing distinct clinical documentation segment.
Commercial carrier adjudications falling beneath Medicare benchmark for major surgical panels.
The Anatomy of a Mednexa Forensic Audit
We do not simply re-run clearinghouse checks. Our certified medical auditors dissect your billing ecosystem across three isolated, forensic audit streams.
Coding & Documentation Integrity
Direct progress note-to-claim interrogation. Our AAPC-certified specialists verify that medical necessity criteria, current E/M 2021/2023 guidelines, operative reports, and specialty add-ons are faithfully transcribed.
- check_circle Chart-to-claim diagnostic match & specificity
- check_circle MDM vs Time-based E/M calibration
- check_circle Operative report unbundling & NCCI validation
Fee Schedule & Payer Benchmark
Practices often absorb silent reimbursement degradation. We cross-reference paid Remittance Advice (ERAs) against contracted fee schedules and regional commercial percentiles to recover systemic underpayments.
- check_circle Commercial vs Medicare RVU percentile analysis
- check_circle Silent adjudication & ERA margin slippage checks
- check_circle Charge master re-indexing recommendations
Compliance & RAC Defense
Protect your assets before targeted payer inquiries happen. We simulate CMS Recovery Audit Contractor (RAC) and Unified Program Integrity Contractor (UPIC) filters against your high-volume clinical codes.
- check_circle OIG Work Plan scrutiny for high-risk targets
- check_circle Modifier -25, -59, -X{EPSU} defense auditing
- check_circle Extrapolation liability containment analysis
4 Hidden Flaws Found in 85% of Audited Clinics
Most lost revenue is not rejected; it is never claimed. Practices unknowingly trade margin for artificial compliance comfort.
Habitual Down-Coding Out of Audit Fear
Physicians routinely submit Level 3 encounters (99213) despite charting thorough Medical Decision Making (MDM) that fully supports Level 4 (99214). This chronic defensive posture surrenders $38 to $54 per patient visit in legitimate reimbursements.
Uncaptured Chronic Care & Complexity Add-Ons
Failure to deploy CMS complexity add-on code G2211 and longitudinal chronic care management (CCM) codes. Clinics forfeiting these codes lose an estimated $16-$32 on qualifying primary and specialty encounters.
Contracted Fee Schedule Non-Compliance
Major commercial payers quietly adjudicating claim lines beneath your mutually contracted fee rates. Without automated line-level audit reconciliation, these silent underpayments blend directly into write-offs.
Superbill & EHR Template Stagnation
Clinical EHR templates often lag behind annual AMA and CMS guideline overhauls. Outdated auto-text macros inadvertently trigger automated claims scrubbing rejections and open the practice to retrospective clawbacks.
The 4-Step Forensic Audit Roadmap
Engineered for minimal practice disruption. Our HIPAA-compliant workflow operates completely in parallel with your live clinical operations.
Secure De-Identified Data Ingestion
Securely transmit 25 to 50 sample clinical encounters via our SOC-2 Type II encrypted SFTP pipeline or grant temporary read-only EHR access.
Blind Dual-Coder Chart Review
Two senior AAPC certified coders independently evaluate each note against billed CPT, HCPCS, and ICD-10 sets without seeing prior reimbursements.
Executive Gap Analysis & Heatmap
Receive a granular line-by-line report illustrating revenue yield captured vs left on table, compliance exposure indexes, and payer vulnerability.
Implementation & Provider Coaching
Senior billing consultants lead a clinical alignment session with your physicians and administrative billing staff to refine templates and workflow.
Interactive Encounter Discovery Ledger
This report represents an illustrative anonymized snapshot. Your practice's customized audit includes up to 50 audited line encounters with complete fee comparison.
“Mednexa’s complimentary audit uncovered $210,000 in unbilled procedural modifiers and corrected our documentation before CMS came knocking. Best clinical investment we made this year.”
Claim Your 100% Confidential Practice Billing Audit.
Gain complete visibility into your under-coding exposure, payer fee compliance, and RAC risk profile. Our team delivers a custom, executive-level gap assessment within 48 hours.
Keep your existing in-house staff or billing agency. This is an objective forensic second opinion.
We execute a formal Business Associate Agreement prior to any encounter transfer.
No automated bots. Real AAPC CPMA and CPC auditors review your clinical charts.
Request 25-Chart Review
Complimentary practice health diagnosticFrequently Asked Audit Questions
Essential details regarding HIPAA protection, sample selection, and forensic deliverables.