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Auditing Services

We offer a full complement of Auditing Services to help you optimize your reimbursement while maintain­ing compliance with regulations. We will identify the strengths and weaknesses of your coding, documentation, billing and reimbursement practices to identify and report opportunities for performance improve­ment. Once areas are identified, we can customize coder and physician education and training to boost your compliance rate. Our auditors are AHIMA credentialed, and each auditor has over 15 years of experience.

Pyramid’s wide range of expertise in Auditing Services include:

  • IM Internal Audit
  • MS-DRG Validation Audit
  • APC- Audit
  • Physician Office (Pro-Fee) Audit
  • Interventional Radiology Audit
  • Cardiovascular Audit
  • Chargemaster Audit
  • OIG High Profile Cases Audit
  • Itemized Charge Detail Audit
  • DRG Review to include Pre and/or Post Bill
  • RAC Audit and Appeals
  • We offer RAC Services from the letter review and managing the Appeals process. We understand the regulations, What to expect, how to prepare and how to help you minimize the financial impact for your organization. We will identify opportunities for performance improvement and help you to calculate the potential reimbursement impacts so that you can prepare accordingly.
  • Nationwide Staffing/Education/Training: Quality AHIMA Credentialed Staff

Optimizing Performance: Helping You to Increase Your Performance

  • Executive Reports
  • Action Plan for all cases with recommendations and reimbursement impact.
  • Summary of Findings
  • Financial Impact Report with original reimbursement and revised reimbursement for each case.
  • Detailed Diagnosis Report for cases with variances.
  • Detailed APC Report for cases with variances.
  • Detailed DRG and APC Claim Report with all auditor comments for cases with variances.
  • Policy and Procedure-Review & Development

Hospital Audit Services Types

  • Inpatient (Includes Medical/Surgical, Cardio, NeuroCare)
  • Audits Pre/Post ICD 10 Implementation
  • Same Day Surgeries/Observations/Outpatient services
  • Radiology: Diagnostic and Interventional
  • Emergency Departments
  • Hospital-based Clinics
  • Facility E&M

Physician Audit Service Types: CPT and HCPCS Coding

  • Surgeries
  • E&M (including Office Visits, Preventative Visits, Observations, Inpatient Services, Consultations and Emergency Services)
  • Inpatient Pediatrics
  • Critical Care
  • Newborn Services
  • Diagnostic Procedural/Surgical Services

PDFAudit Services Printable PDF