The situation
Site-of-service rules were applied inconsistently, so modifier 26 and TC assignment did not match where the study was performed.
Multiple procedure reduction sequencing was left to the clearinghouse, which cost the group on imaging families.
What we did
- 01
A coding audit quantified the component-billing error rate and its dollar impact per modality.
- 02
Site-of-service logic was mapped per facility contract and enforced at coding.
- 03
Procedure sequencing rules were applied before submission rather than after adjudication.
The result
- — Collections rose 22% with no change in study volume.
- — Modifier-related denials fell 44%.
- — Coding accuracy reached 98.9% on audit sampling.
"Twenty-two percent more revenue from the same work. That is the entire argument for auditing coding annually."