Nobody has independently checked your coding.
And the company doing the coding is the one telling you it's fine.
A CPMA reviews a defined sample of encounters from your practice and gives you a written finding — what your documentation supports, what it doesn't, and what it's costing you in both directions. Flat fee. No commitment beyond the audit.
You will reach a certified specialist, not a queue.
A paid claim is not the same thing as a correct claim.
Payment isn't a payer's verdict on your accuracy. It's an advance, issued on the assumption your documentation supports what you submitted — and it stays reversible long after the deposit clears. Which means a practice can have a healthy clean claim rate, a low denial rate, and steady deposits while carrying exposure that nothing in its monthly reporting would reveal.
In our experience the practices with the most exposure are rarely the disorganized ones. They're the ones running smoothly enough that nobody has had a reason to look.
What We Examine
Six things. Each one compares the note in the chart to the code on the claim — one encounter at a time.
E/M level validation
Does the documented medical decision making support the level billed? Highest-volume risk in any outpatient practice, and the finding we encounter most.
Modifier support
Every modifier 25 needs a separately identifiable service visible in the note — not implied by the presence of two charges. Every modifier 59 needs distinct anatomy, session, or encounter. Modifiers appended by workflow habit are a recurring pattern, and among the easiest for a payer to spot in aggregate.
Medical necessity and diagnosis linkage
Does the diagnosis reported actually establish necessity for the service performed, or was it selected to clear an edit?
Documentation adequacy
Whether the note, read cold by someone who wasn't there, supports what was billed. Where time drove the level, whether that time is documented in a way that survives review.
Copy-forward and cloned documentation
A note that grows more detailed each visit while the patient's complexity stays flat is a pattern visible from outside your practice. Usually a workflow artifact, not intent — but easier to explain before a payer raises it than after.
Incident-to and supervision
Whether encounters billed under a supervising provider actually meet establishment and supervision requirements, or whether the billing provider was assigned by habit.
A written report. Not a score.
An audit that produces a percentage and a verbal summary hasn't given you anything you can act on. Yours identifies:
- Each finding with the specific encounter behind it — Chart, date, code, what was documented.
- What the documentation would have needed — To support the code billed.
- Exposure quantified in both directions — Over and under.
- What to correct going forward — Separated from anything that may warrant a broader look-back.
The point isn't to grade you. It's to give you a defensible position and a specific list of things to change.
The Findings Run Both Ways
Most owners avoid this review because they expect one outcome: a number they owe back. That expectation is what keeps it off the calendar year after year.
In practice, findings split. Undercoding out of caution is at least as common as the opposite — and it's expensive in a way that generates no signal at all. There's no denial. No appeal. No report showing it. The practice simply under-collects, permanently, on every encounter matching the pattern.
A provider who levels conservatively out of fear of an audit can cost a practice more over a year than an occasional overcoded claim ever would.
Scope and Cost
- Sample
- A defined set of encounters, selected across providers and service types.
- Fee
- Flat fee, quoted on the call once specialty and volume are known.
- Turnaround
- A fixed window from receipt of records, agreed up front.
- What we need from you
- Read-only access to the charts and the corresponding claims. Nothing else.
- Commitment
- None. The audit is a standalone engagement.
When This Isn't Worth Your Money
We'd rather tell you on the call than take the fee.
An audit is probably not the right spend right now if you're a single provider seeing very low encounter volume, if you've had an independent coding review in the last twelve months with no significant findings, or if you already know your problem is on the collections side — unworked denials and aged receivables — rather than the coding side. That's a different review, and we'll tell you so.
Who Does It
Auditing is a distinct discipline from billing and coding, which is why it carries its own certification. These audits are led by a Certified Professional Medical Auditor (CPMA), working alongside the CPC and CRC credentials that support our billing and coding work.
HEMBILLING has served independent and specialty practices across South Florida for seven years. We are based in Pembroke Pines, and you will talk to the person doing the work.
Questions We Get
Do I have to switch billers?
No. Most practices that run an audit with us keep their current biller. The audit is a standalone engagement and works the same whether your billing is in-house or outsourced.
Will this create a problem I don't currently have?
The exposure exists or it doesn't — a review doesn't create it, it locates it. What a review changes is whether you find it first. Practices that review their coding on a regular schedule are rarely the ones facing a repayment demand, because corrections happen while they're still small and still prospective.
What happens if you find something significant?
We show you exactly what we found and what supports it. What to do next — correct prospectively, or look back further — is your decision, and for anything material we'll tell you plainly that it's a conversation to have with your healthcare counsel rather than with your biller. We don't make that call for you.
Can you review before claims go out instead?
Yes. Pre-bill review catches an error as a correction rather than a refund. Most practices need both, in sequence: a post-bill sample to establish where things stand, then pre-bill review on whatever the sample surfaces.
Is this HIPAA compliant?
Yes. We work under a BAA, and record access is read-only and limited to the sample.
Correct it before someone else finds it.
If you've never had an independent review of your coding, book a 20-minute call. We'll ask the right questions, tell you honestly what we're seeing, and tell you just as honestly if we don't think an audit would find enough to be worth your money.
You will reach a certified specialist, not a queue.
Prefer to ask a question first? Send us a note and we'll reply within one business day.