The Breakdown · Anatomy of a Federal Audit
The match found the money. The charts only agreed.
One query across 240,401 patients and 554 plans flagged acute stroke codes with no hospital trail. When the records arrived, every sampled chart failed, most of them on two words: "history of."
- For coding, HIM and revenue integrity leaders: how the OIG match works, step by step, and why the failure lives in problem lists rather than with coders.
- Comes with a five-step self-match protocol, the eight code families OIG has published conditions for, and a formula that sizes exposure and missed revenue alike.
In the Breakdown
Run the auditor's query before the auditor does.
The mechanics of the audit, and the same instrument pointed at your own claims.
The funnel.
773,999 enrollees to $462.0M, identified before a single chart was requested.
Figure discipline.
Why 90%+ is an allegation and 97% is a finding, and what blending them costs you.
Self-match protocol
Two claim streams, one flag condition, exclusions, review before submission.
Eight families.
Stroke, heart attack, embolism, depression, four cancers and more, each with its match condition.
The flip.
The same query run backward finds documented conditions nobody coded.
Sources.
The OIG audit, its 2023 toolkit with published SQL, and the 2021-2025 audit series.
Why RapidClaims
Consistency between claim streams is now an audited property.
RapidClaims checks each code against the clinical trail before submission, catching an acute code with no hospital event, and a documented condition that never reached the claim.
>95%
Coding accuracy
Across 25+ specialties, including the complex ones competitors avoid.
40%
Fewer denials
Documentation gaps caught at the point of code, before submission.
25+
Specialties supported
Depth in the hardest specialties, not just the easy volume.
>90%
Charts auto-coded
Autonomous at an enterprise-grade accuracy threshold.
1.7×
Coder productivity
More charts per coder — without adding a single FTE.
<6 wks
To go-live
From signed agreement to live coding in your environment.