Clinical Department Coding Audit

This evaluation will review a stated amount of hospital outpatient claims for Coding accuracy based upon hospital supplied documentation, UB-04’s and Itemized bills. The hospital will provide a complete years’ worth of 837 (electronic claims) and 835 (electronic remits) upon a mutually agreeable format for analysis. Wellington will analyze and flag claims using their proprietary clinical coding edits to identify potential claims that have coding errors which might be costing the hospital valuable revenue. Wellington will produce a detailed report of each claim audited for potential coding errors based upon supplied documentation. The report will utilize Medicare APC payments as the basis for the financial evaluation unless hospital provides other appropriate fee schedule or payment structure for an individual payer. The final review will provide one-on-one review with impacted departmental staff or coders based upon results provided to senior management.


The Wellington Group, LLC
6133 Rockside Rd, Suite 205
Independence, OH 44131
Phone: 216.525.2200
Fax: 216.525.2201
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