Potential Overpayment Exposure
Unsupported code levels, modifier issues, or other coding errors may warrant additional review.
Acquisition Due Diligence Coding Audits
Before You Acquire a Practice, Understand the Coding Risks Behind Its Revenue.
Independent, specialty-specific coding and documentation reviews from The Coding Network to help private equity firms, health systems, and their advisers identify potential compliance exposure, overpayment risks, and undercoding before closing.
For orthopedic and other physician-practice acquisitions. Audit scope is tailored to the target and transaction.
USA-Based Auditors
Coders and auditors based in the United States.
Specialty-Specific Expertise
Reviewers matched to the target practice's specialty.
Independent Third-Party Review
Objective coding and documentation audits.
The Transaction Problem
The Financials Show the Revenue. Coding Diligence Examines Its Support.
A financial review and a coding review answer different questions. Reviewing selected encounters against the supporting documentation can reveal coding issues that warrant further investigation before a transaction closes.
Undercoding & Missed Supported Services
Documentation may support services that were coded incorrectly or incompletely.
Documentation Weaknesses
Gaps may make billed services harder to substantiate.
Not every coding error is fraud, not every acquisition transfers all historical liabilities, and undercoding does not automatically create recoverable revenue. A coding review identifies issues that merit further diligence.
What the Audit Can Review
A Focused Review of Coding and Supporting Documentation
These are potential review areas, subject to the agreed scope. The review does not cover every claim, every payer rule, or every service line.
- Agreement between selected coded services and clinical documentation
- Procedure and diagnosis code assignment
- Evaluation and management coding, where applicable
- Modifier use and bundling issues
- Documentation supporting the reported services
- Patterns that merit expanded review or corrective action
- Potential overcoding and undercoding
Practice Acquisitions
Planning a practice acquisition? Discuss a review focused on the target's procedures, office-based services, modifiers, and supporting documentation.
The same approach can apply to other specialties, subject to confirmation of scope.
Proposed Deliverables
Findings Your Deal Team Can Act On
Deliverables are confirmed during engagement scoping. TCN does not promise a statistically valid population-wide exposure estimate, a definitive purchase-price adjustment, a legal opinion, a guaranteed reduction in liability, an exact turnaround time, or a specific unapproved reporting format.
- A summary of findings from the reviewed sample
- Coding and documentation issues identified
- Potential overcoding and undercoding patterns
- Prioritized questions for additional diligence
- Recommended coding and documentation improvements
Deliverables, sampling approach, and timing are established during engagement scoping.
Why TCN
Specialty-Specific Expertise for a High-Stakes Decision
Matching the auditor's expertise to the target's specialty matters. Coding conventions, documentation expectations, and risk patterns vary by specialty — a reviewer fluent in that specialty is better positioned to identify issues that matter to the transaction.
Independent Third-Party Audits
Objective coding and documentation audits conducted outside the target practice.
USA-Based Coders & Auditors
Reviewers based in the United States, working to consistent audit standards.
Specialty-Specific Expertise
Auditors matched to the target's specialty for relevant, focused review.
Five Years of Specialty Experience
Auditors must have at least five years of specialty-specific coding experience within the past five years.
Specialty-Specific Proficiency Testing
Auditors complete proficiency testing specific to their assigned specialty.
TCN can work alongside your deal team and multiple consulting partners on the coding and documentation review workstream.
Process
Start With the Transaction. Define the Right Audit.
01
Discuss the Target
Share the target practice, specialty, and transaction timeline so TCN can understand the context.
02
Agree on Scope
Define review scope, sampling approach, required records, and deliverables for the engagement.
03
Review Findings
Receive findings and identify priorities for further diligence or improvement.
FAQ
Common Questions
Private equity investment and operating teams, health-system acquisition and corporate development teams, physician practice platforms and MSOs, and healthcare transaction consultants and advisers.
Request an Audit Discussion
Acquiring a Practice? Start With a Coding Diligence Conversation.
Tell us about the target's specialty and your transaction timeline. TCN can discuss an appropriate scope for reviewing coding and supporting documentation.
Do not submit patient information, medical records, claims, or other protected health information through this form.
Discuss your acquisition coding audit.