Solutions · Compliance & Audit

Auditing Solutions

Know Your Coding Is Right - Before a Payer Tells You It's Wrong

Ongoing coding quality reviews, audits, and compliance validation - built to catch issues before payers do.

Valerion Health's auditing team reviews coding quality, documentation support, and compliance posture on an ongoing basis, so problems get caught internally - long before they surface in a payer audit.

Talk to an Auditing Specialist See the three disciplines

CPTICD-10-CMICD-10-PCSHCPCSCMS · OIG

Sample audit review

Pass · no findings

E/M99214Level supported by documentation
CPT45380Procedure validated against the note
DXE11.9Diagnosis specificity confirmed
DOCSIGNProvider authentication present

Reviewed · Validated · Audit-ready

Where Auditing Sits

The checkpoint that verifies every other checkpoint.

Everything upstream produces codes and documentation. Everything downstream assumes somebody verified them.

Documentation

The clinician records care

Coding

Codes assigned to the encounter

You are here

Audit & validation

Where accuracy gets verified

Claim submission

Scrubbed, edited, sent

Payer / RAC review

Someone else checks your work

01
Documentation
The clinician records care
02
Coding
Codes assigned to the encounter
You are here
Audit & validation
Where accuracy gets verified
04
Claim submission
Scrubbed, edited, sent
05
Payer / RAC review
Someone else checks your work

From that one review, a coding error can only end up in three places.

Target

Caught internally

Corrected before the claim leaves. A quiet fix, not a finding.

Cost

Caught by the payer

A denial, a records request, or a recoupment months later.

Cost

Never caught at all

The same error repeats across hundreds of claims.

Why It Matters

Small verification gaps compound into large compliance exposure.

One unaudited coding pattern

an error that repeats across hundreds of claims before anyone notices

One missed compliance gap

an audit finding instead of a quiet correction

One unprepared RAC or payer audit

exposure that could’ve been caught internally

One uncorrected documentation gap

risk that compounds with every claim that follows

Coding accuracy isn't a one-time achievement. It's a discipline that has to be verified continuously - so you know your coding program is working, instead of assuming it is.

Our Approach

How Valerion Health Helps

Continuous auditing that strengthens coding quality, ensures compliance, and validates accuracy against current regulatory standards.

Coding Quality Audits

QA samplingError trendingCoder feedback

Coding accuracy isn’t something to assume - it’s something to verify on an ongoing basis. Reviews run continuously across coders, specialties, and claim types, so issues surface as patterns rather than one-off surprises.

Ongoing accuracy reviews across coders, specialties, and claim types
Error trending that identifies patterns, not just isolated mistakes
Coder-level feedback that improves accuracy at the source
Consistent quality standards across your entire coding operation

The result: Coding accuracy that’s verified, not assumed, with issues caught and corrected before they reach a claim.

Internal & External Audits

Pre-billPost-billRACPayer

Whether it’s a routine internal check or an incoming payer, RAC, or government audit, preparation is what determines the outcome. We conduct pre-bill and post-bill reviews and provide audit-readiness support, so your organization is never caught off guard.

Pre-bill reviews that catch errors before claims go out
Post-bill reviews that verify accuracy after submission
Audit-readiness support for payer, RAC, and government audits
Clear documentation trails that hold up under scrutiny

The result: An organization that’s consistently audit-ready, with fewer surprises and stronger outcomes when external audits do occur.

Compliance Reviews

CPTICD-10-CMICD-10-PCSHCPCSCMS · OIG

Coding rules change constantly, and staying compliant means validating every code against current standards. We assess coding practices against CMS, OIG, and payer guidelines - across CPT, ICD-10-CM, ICD-10-PCS, and HCPCS - to close gaps before they become liabilities.

Full validation across CPT, ICD-10-CM, ICD-10-PCS, and HCPCS
Documentation compliance checks built into every review
Coding practices assessed against CMS, OIG, and payer guidelines
Gaps identified and corrected before they surface as findings

The result: Coding compliance you can defend, and audit exposure reduced before it ever becomes a finding.

Common Challenges

Common Challenges We Solve

If this sounds familiar, we should talk.

No consistent process for coding quality checks

Blind spots between internal coding practices and payer expectations

Limited preparation heading into payer, RAC, or government audits

Coding errors that keep repeating because they’re never systematically identified

Compliance gaps that go unnoticed until an external audit finds them

Limited internal audit capacity or specialty-specific expertise

The Impact

Preventable compliance exposure, repeat coding errors, and audit findings that could've been caught internally.

Valerion Health exists to close these gaps - permanently.

FAQ

Auditing & Compliance, Questions Answered

A defensible healthcare compliance program is built on seven elements: written policies and procedures, designated compliance leadership, effective staff training, open internal communication channels, ongoing monitoring and auditing, consistent enforcement of standards, and a clear process for responding to violations. Valerion Health's medical billing compliance services are structured around all seven, providing audits, documentation reviews, and staff education that keep your organization protected from payer scrutiny.

Let's talk

Stop finding out about coding issues from a payer audit.

Let's build an auditing program that catches risk before it becomes exposure, and keeps your coding accuracy verified - not assumed.