AI-Assisted Medical Coding & Chart Review

High-accuracy coding at optimized cost and faster turnaround with dual-layer human QA validation.

Our Objective

Provide high-accuracy coding at optimized cost and faster turnaround.

Service Model Overview

Our hybrid approach ensures:

⚡ Speed of Automation

Artificial Intelligence for initial chart analysis and rapid code generation.

✓ Accuracy of Human Expertise

Certified human coders for validation and quality assurance.

📋 Compliance Assurance

Dual-layer QA review before final delivery for payer and audit compliance.

Services Included

Outpatient Medical Coding

Comprehensive coding for outpatient services and encounters

Physician Professional Coding

Accurate coding of physician services and professional fees

ICD-10-CM Diagnosis Coding

Precise diagnosis classification and coding accuracy

CPT Procedure Coding

Current Procedural Terminology coding with modifier optimization

HCPCS Coding

Healthcare Common Procedure Coding System expertise

Modifier Validation

Accurate modifier application and compliance verification

Medical Necessity Verification

Documentation review ensuring medical necessity support

Coding Audit Support

Comprehensive support for compliance and audit readiness

AI-Assisted Coding Workflow

1

Secure Document Intake & Storage

Client charts are received through secure transfer channels. Documents are stored in a HIPAA-compliant, access-controlled platform.

2

AI-Based Clinical Data Extraction

Relevant diagnoses, procedures, and clinical indicators are identified. Draft ICD-10, CPT, and HCPCS codes are generated based on documentation.

3

Primary QA Validation (Human Review)

Certified QA coders review AI-generated codes. Coding corrections and clarifications are applied where required.

4

Secondary QA Audit (Dual-Layer Review)

Senior QA auditors perform independent validation. Modifier accuracy, medical necessity, and payer rules are reviewed. Compliance with LCD/NCD and specialty guidelines is confirmed.

5

Final QA Approval & Delivery

The prQA Lead performs final quality sign-off. Approved charts are finalized for delivery. Output files are securely delivered to the client as per SLA.

Dual-Layer QA Validation Model

Only charts passing both QA layers are delivered.

QA Coder Review

Reviews AI-generated codes
Validates clinical relevance
Corrects discrepancies
Ensures documentation support

Senior QA Audit

Accuracy verification
Modifier correctness
LCD/NCD alignment
Compliance confirmation

Why Dual QA Is Critical:

  • Reduces coding error risk - Multiple validations catch discrepancies
  • Prevents payer denials - Compliance verification before submission
  • Improves first-pass acceptance rate - High-quality codes reduce rejections
  • Ensures audit-ready documentation - Comprehensive support trails
  • Protects provider revenue - Accurate coding maximizes reimbursement

This model costs more than single review — but significantly reduces downstream financial losses.

Staffing Structure

Each client is supported by:

🤖

AI Processing Engine

Initial clinical analysis

👥

Certified QA Coders

Primary validation

🔍

Senior QA Auditor

Secondary review

QA Lead

Escalation & approval

🛟

Support Team

Dedicated assistance

This ensures no chart is delivered without human validation.

Typical Staffing Allocation Example

Staffing scales proportionally based on chart volume and complexity.

For Monthly Volume: 5,000 Charts

5–6

Primary QA Coders

2

Senior QA Auditors

1

QA Lead

1

Operations Support

Ready to Optimize Your Coding Operations?

Our AI-assisted medical coding services with dual-layer human QA validation deliver high accuracy, faster turnaround, and compliance assurance. Let us help you reduce coding errors, prevent denials, and maximize revenue recovery.

Schedule a Consultation Today