Coding, CDI, and ROI by credentialed humans. Audited every quarter.
CPC, CCS, CCDS, and RHIA professionals organized by specialty. not by client. Pre-bill audits on a stratified sample. CDI feedback that loops back to the providers who need it. Quarterly external audits we publish to clients.
on monthly audit
Six functions, all under one credentialed lead.
HIM done right is a quiet function. you only hear about it when something fails an audit or a payer claws back. Below is the scope we run, with the credentials we run it with.
Inpatient & outpatient coding
CPT, ICD-10-CM/PCS, HCPCS, MS-DRG, APR-DRG. Specialty-aligned benches. surgical, ED, hospital inpatient, outpatient procedures. not a generic pool.
HCC & risk-adjustment coding
Risk-adjustment coding for MA, ACA, and value-based contracts. Full audit trail per chart. Provider-level RAF trending so leadership can see where documentation is leaving money on the table.
Clinical Documentation Improvement
CDI specialists embedded with the coding bench, not in a silo. Provider-level coaching in plain language. Query rate, response rate, and impact on case-mix tracked and reported.
Release of Information (ROI)
HIPAA, HITECH, and state-specific compliance. Patient, payer, attorney, and continuity-of-care requests handled with same-week turnaround for routine, 24-hour for urgent.
Coding audits & compliance reviews
Pre-bill, retrospective, and focused-issue audits. Stratified sampling, written findings, root-cause analysis, and remediation plans. Audits we run are the audits we’d want done on us.
RAC & payer audit defense
Full appeal lifecycle. from initial determination through ALJ. Clinical and coding expertise on every appeal. Timeline discipline so deadlines never lapse.
From baseline to quarterly external audit.
A predictable cadence. Same senior HIM partner from baseline to steady state, with an external auditor reviewing our work every quarter.
Baseline accuracy audit
External coder samples 100+ charts across service lines. Accuracy baseline locked.
Bench & QA stand-up
Specialty benches assigned, QA workflow loaded, EHR access provisioned. CDI rounds scheduled.
Cutover & first QA
First month of coding under our team. Internal QA at 5% sample. Findings reported to client.
External audit
Third-party auditor reviews 100+ random charts. Report shared with the client’s compliance officer.
CDI & provider feedback
Monthly provider-level coaching. Documentation gaps closed at the source, not retroactively queried.
Where the coding edge cases actually live.
Generic coders miss specialty-specific revenue. Below are the areas where our dedicated benches operate. not a marketing list, the actual benches with credentialed leads.
Surgical & procedural
Multi-specialty surgery (gen, ortho, neuro, cardiac, plastics). Modifier 22, 51, 59, 78, 79 nuance handled correctly.
Hospital inpatient
MS-DRG and APR-DRG optimization. Sepsis, AKI, malnutrition CDI. Two-midnight rule, observation conversions.
Emergency department
E/M leveling, critical-care time, observation, splinting, FB removals. ED-specific facility-vs-pro split.
Risk-adjustment / HCC
MA, ACA, ACO. v24 and v28 model awareness. MEAT-supported documentation. Provider-level RAF trending.
Behavioral & ABA
Authorization-heavy, modifier-sensitive coding. State Medicaid quirks. Time-based unit conversion.
SNF & post-acute
PDPM, MDS-driven coding, PT/OT/ST units. Triple-check workflow on therapy minutes & nursing case-mix.
Six outcomes. Every one auditable.
HIM metrics are gameable if the auditor and the auditee are the same team. Ours aren’t. the QA sample is independent, the external audit is third-party, and findings are shared with your compliance officer before they reach the senior partner.
| METRIC | TARGET | HOW WE MEASURE IT |
|---|---|---|
| Coding accuracy | 95%+ | Random monthly sample, 5% of charts. Independently re-audited externally each quarter. |
| DNFB days | < 4 days | Discharged-not-final-billed cycle time. Tracked daily, reported weekly to revenue cycle leadership. |
| CDI query response rate | > 90% | % of provider queries answered within the response window. Tracked per provider, coached monthly. |
| Case-mix index lift | +2-5% | Specialty-adjusted CMI movement attributable to documentation, not to volume mix. |
| ROI turnaround | 7 / 1 days | 7 calendar days for routine, 1 business day for urgent. Tracked weekly with the compliance officer. |
| Audit overturn rate | 60%+ | RAC / commercial post-pay overturn rate, dollar-weighted. Senior partner reviews high-dollar lanes. |
Coders organized by specialty, not by client.
Most HIM vendors organize their floor by client account. one team for every client, mixed-bag charts. We organize by specialty: a surgical bench, an ED bench, an inpatient bench, an HCC bench. The same coder sees enough volume in their lane to learn the edge cases, and that’s where the revenue is.
Specialty depth, not breadth theater.
- Same-bench tenure. specialty leads have 5+ years in the same lane, not 5 years across 5 lanes.
- Edge-case capture. modifier 22, 59 nuance, two-midnight, MEAT-style HCC documentation.
- Provider trust. CDI specialist is the same face every month, not a rotating ticket queue.
- Compliance-officer access. your compliance officer talks to our specialty lead directly.
- External audit, every quarter. third-party verification, results published to the client.
Four outcomes. Independently audited.
Get a free 25-chart audit.
Send us 25 recent charts. We’ll send back a written accuracy assessment with re-codes and a specialty-by-specialty risk read. No obligation.