Healthcare Claims and Compliance Audits

Our skilled audit team reviews medical records and coded claims to determine if what was documented by the provider is correctly conveyed in the most appropriate coding structure.  We also conduct comprehensive reviews of various healthcare organizations through independent reviews to assure adherence to regulatory guidelines, policies, HIPAA compliance, and risk.  Our processes include reviews of guidelines, regulations, and policies, interviews of staff, and review of audit trails which is turned into a defined action plan.

Catapult developed the audit protocols currently being used nationwide by the Medicaid Integrity Contractors (MICs). We were the first contractor to perform Medicaid Program Integrity audits (“Test Audits”) in conjunction with the States.  Our ability to deliver truly meaningful results in a cost effective manner was noted in the June 2012 GAO Report entitled “National Medicaid Audit Program.”

Our experience in conducting Medicaid audits spans a variety of provider types, including physicians, dentists, hospitals, psychiatric institutions, home health agencies and durable medical equipment (DME) providers.