Audit Support Services

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THE NEED: With the countless challenges that impact healthcare facilities and providers today, it has never been more important to clinically document to satisfy reporting requirements for services including E&M visits, surgical procedures, supplies and other ancillary services.  As the healthcare industry in the United States continues to become more patient-centered and data-driven, the need for complete clinical documentation and accurate coding and billing procedures has never been more essential.  

HOW WE HELP: The Medical Management Institute performs thousands of documentation and coding reviews each year. The reviews we perform encompass Evaluation and Management (E&M) services and the other applicable aspects of coding and billing for providers in all settings.  The Medical Management Institute offers several audit strategies based on individual client’s situational needs.

WHAT WE DO: Considering the extensive updates to CPT outpatient E&M coding guidelines launched in 2021 and the everchanging CMS reporting requirements – now is the time to assess your providers’ documentation and coding competencies. Complete and timely documentation is paramount for a healthy revenue cycle.  In our experience, clinical providers gain more insight and awareness of the complicated rules related to coding and billing based on reviews of their own clinical documentation as opposed to using generic examples to educate the providers. The audits conducted by The Medical Management Institute are intended to assist providers and the entire revenue cycle team to mitigate 3rd party audit risk exposure, maximize revenues and to foster compliant coding and billing initiatives.

The typical audit process for each provider we review includes a 10-20 patient encounter sample. We suggest a sample reflecting a wide array of services that represents the full variety of services (e.g., new patients, established patients, preventive medicine, minor procedures, etc.). Documentation for each case will be carefully considered as described below:

  • Evaluation and Management (E&M) services are always a central focus of the reviews provided by The Medical Management Institute
  • The accuracy of CPT/HCPCS-II modifiers
  • The accuracy, specificity and assignment of ICD-10-CM codes
    • Following the audit, an executive summary and completed audit template are forwarded to the client for each provider reviewed, which demonstrates coding error rates and applicable findings related to the review.
    • Optional provider training (typically 30-45 minutes) is arranged following the review to assist with corrective action measures and to address any questions the providers may have.


  • HIPPA-compliant Business Associate Agreement (BAA) must be executed before the dissemination of any Protected Health Information (PHI) to adhere to HIPAA and HITECH requirements.
  • The Medical Management Institute uses a HIPAA-compliant Citrix service called ShareFile for the transmission of electronic health records and all documents containing protected health information (PHI). Account access is assigned once the scope of service agreements is executed.
  • A pre-populated Microsoft Excel spreadsheet will be forwarded to you to enter the patient demographic information and the specific CPT/HCPCS-II/ICD-10-CM codes that were reported by the provider
  • The data is reviewed by our experienced audit team and following the generated report, a time will be set for provider training which can be provided remotely or on-site (any expenses for on-site training will be invoiced separately).