Medical Coding Audit Software

The vendor is required to provide a comprehensive software solution to support and enhance its medical coding audit program.
- This program includes both routine audits of coders and clinicians as well as quality assurance (QA) audits performed by the coding leadership team.
- Software should be intuitive, scalable, and capable of adapting to the university’s evolving needs as audit volumes increase.
- The software solution must, at a minimum, include:
1. Comprehensive audit tracking:
• Ability to collect and organize all details related to each medical coding audit, including audited encounters, assigned codes, reviewer findings, and documentation notes.
2. Customizable reporting and analytics:
• Robust reporting functionality that allows data to be filtered and reported by department, division, coder, auditor, and other relevant categories.
• The solution must provide the ability to identify trends in audit results over time and support performance improvement initiatives.
3. Coder feedback and dispute resolution workflow:
• A built-in feedback loop that allows coders to view audit findings, submit rebuttals, and track the resolution process.
• The software should include functionality to manage and document tie-breaker decisions where coder and auditor assessments differ.
4. Integration with clinical and billing systems:
• Capability to interface with or import relevant data from the university’s electronic medical record (EMR) system, cerner power chart, and the billing system, athena idx. 
• This may include clinical documentation, coding records, and billing details necessary to support audit activities.
5. User access and security:
• Support for secure, role-based access to ensure appropriate visibility and control for auditors, coders, leadership, and other stakeholders. 
• The solution must comply with HIPAA and institutional data security policies.
6. Scalability and flexibility:
• The system must be able to accommodate an increasing number of audits and users over time without performance degradation.
7. Technical support and training:
• Provide implementation support, user training, and ongoing technical assistance to ensure successful adoption and use of the platform.
• This software solution will play a critical role in supporting audit accuracy, compliance, and coder development within university physicians.
• Solutions that offer additional value-added features such as benchmarking, customizable dashboards, or mobile access are encouraged.
- Audit management
• Ability to perform audits of both coders and clinicians, including routine and QA audits.
• Configurable audit templates supporting multiple service types (e.g., e/m, surgical, diagnostic, anesthesia).
• Workflow support for assigning, reviewing, and tracking audits by department, division, coder, and clinician.
• Real-time audit tracking and dashboards for status visibility and task management.
- Rebuttal & tie-breaker workflow
• Built-in feedback loop allowing coders to submit rebuttals.
• Functionality to escalate audits for third-party review and resolution.
• Complete audit history and final determination tracking with timestamps.
- Reporting & trend analysis
• Standard and custom reports trending audit outcomes over time by:
• Department
• Division
• Coder
• Clinician
• Audit type
• Date range
• Visual dashboards with drill-down functionality and export options (pdf, excel, csv).
• Ability to analyze error categories and identify training or compliance gaps.
- System integration
• Capability to interface with cerner power chart (EMR) and athena idx (billing system) via:
hl7, FHIR, API, or secure flat-file exchange.
• Configurable data mapping for inbound fields (e.g., MRN, encounter id, provider NPI).
• Optional real-time or scheduled data pulls.
- Data management
• Secure storage and retrieval of audit data with export available in non-proprietary formats (csv, xml, json).
• Support for at least 500 concurrent users and scalability to ≥500,000 audits per year.
- Customizability
• Administrative tools for configuring:
• User roles and permissions
• Audit templates and scoring rubrics
• Reporting dimensions and filters
• No vendor development required for configuration changes.
- Accessibility
• Fully functional on current versions of chrome, edge, safari, and Firefox.
• Responsive design compatible with desktops, laptops, tablets, and smartphones.
• No degradation of core features across device types.
- HIPAA & security standards
• Full compliance with HIPAA privacy and security rules.
• Certification in at least one of the following: SOC 2 type ii or ISO 27001.
• Annual evidence of compliance and security posture updates.
- Data privacy and ownership
• All university data is confidential and may not be accessed, used, or shared by the vendor without explicit written consent.
• No data usage for AI model training, analytics, or third-party distribution.
- Business continuity
• In the event of acquisition, business closure, retirement, or bankruptcy, the vendor must:
• Transfer full control of the source code to the university with perpetual rights, or maintain an escrow agreement granting the university access under those conditions.
- Data portability
• University must have access to export data at any time without additional cost or restrictions.
• Data must be provided in industry-standard formats suitable for migration or reporting.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: July 08, 2025