Audit Defense

Audit Requests Take 15-30 Hours. You Don't Have a Compliance Department.

Small practices defending RAC, CERT, and payer audits alone spend weeks searching for evidence. One missing document costs $50K-$500K in downcoding. Evidence-linking provides 60-second audit response with claim-level audio timestamps.

Built for Practices Without Compliance Departments

Small groups (2-20 providers) facing Medicare audits without dedicated legal teams. High Medicare volume practices needing instant audit defense. Emergency medicine and high-risk specialties defending alone. Enterprise health systems have compliance departments; you need 60-second evidence-linking.

Small Practices Know This Reality

Unexpected Audit Requests

RAC, CERT, payer audits with 30-45 day deadline

No Compliance Department

Small practices defending audits without legal teams

Documentation Search

15-30 hours searching for visit audio and notes

$50K-$500K Downcoding Risk

Lost revenue when can't prove medical necessity

Defend Audits in 60 Seconds Instead of 15-30 Hours

60-Second Audit Response

Claim-level audio timestamps provide instant proof of medical necessity

7-Year Audio Retention

Long-term compliance storage included, exceeding industry standard

Evidence-Linking Technology

Bidirectional links between claims and audio segments

Medical Necessity Proof

Exact moment clinical decision documented and timestamped

Automatic Organization

Claims tagged with relevant audio segments automatically

Defensible Documentation

SOAP notes with audio backup for complete audit trail

Proven Results in Audit Defense

95%
Time Reduction
15-30 hours → 60-90 minutes per audit
$50K-$500K
Downcoding Avoided
Prove medical necessity with timestamped audio
7 years
Audio Retention
vs 30-90 day industry standard
60 seconds
Audit Response Time
Instant claim-level evidence retrieval

Streamlined Audit Defense Workflows

RAC Audit Response

  1. 1. Receive audit request for 20 claims
  2. 2. Open OrbDoc audit dashboard
  3. 3. Select flagged claims and pull evidence in 60 seconds
  4. 4. Review audio timestamps showing medical necessity
  5. 5. Submit response same day with complete audio proof

Payer Pre-Payment Review

  1. 1. Commercial payer flags claims for review
  2. 2. Access claim-level audio timestamps instantly
  3. 3. Provide audio proof of patient conversation and clinical decision
  4. 4. Submit documentation within 24 hours
  5. 5. Get paid without denial

CERT Audit Defense

  1. 1. Random Medicare selection for comprehensive review
  2. 2. Pull complete encounter audio with timestamps
  3. 3. Demonstrate medical necessity with exact conversation
  4. 4. Pass audit with zero findings
  5. 5. Maintain clean audit record

How Evidence-Linking Technology Works

Every claim automatically linked to timestamped audio proof

1. Voice Documentation

  • Voice documentation captured during patient encounter
  • AI automatically links clinical findings to billing codes
  • Audio segments timestamped to specific claim elements
  • Encrypted storage with HIPAA-compliant 7-year retention
  • One-click audit response package generation

2. Automatic Linking

  • Chief complaint → ICD-10 diagnosis codes
  • History of present illness → Medical necessity
  • Review of systems → E/M level support
  • Physical exam findings → Procedure codes
  • Medical decision-making → Complexity level

3. Secure Storage

  • HIPAA-compliant encryption at rest and in transit
  • Role-based access control (only authorized users)
  • Audit trail of all evidence package access
  • 7-year retention meets Medicare/Medicaid requirements
  • Geographically redundant backup storage

Example: E/M Level 4 Audit

Auditor questions: "How do you justify level 4 complexity?"

Evidence-Linking Response: Audio timestamp 4:32-6:18 captures detailed history of present illness with 4+ chronic conditions, timestamp 11:15-14:40 documents comprehensive review of systems, timestamp 18:22-22:10 shows complex medical decision-making discussion with patient.

Success Patterns from Practices Using Evidence-Linking

High Medicare Volume Practices

Practices with 60%+ Medicare patients facing frequent RAC and CERT audits report consistent patterns:

  • Audit response time reduced from 15-30 hours to 60-90 minutes
  • Downcoding avoided with timestamped audio proof
  • Same-day audit responses without evening chart reconstruction

Small Practices Facing First Audit

Solo and small groups (2-5 providers) without compliance departments defending their first major audit:

  • In-house 60-second response capability reduces external consultant needs
  • Confident coding with timestamped evidence
  • Same-day responses replace weeks of chart review

Emergency Medicine & High-Risk Specialties

EM physicians, surgeons, and high-risk specialties facing liability exposure and frequent payer scrutiny:

  • 7-year audio retention for malpractice defense protection
  • Timestamped clinical decision-making for every encounter
  • Defend complex cases with exact conversation timestamps

6 Audit Scenarios Where Evidence-Linking Protects You

Medicare RAC Audits

High Frequency

Common Audit Focus Areas:

  • E/M coding levels
  • Medical necessity documentation
  • Documentation completeness
  • Upcoding claims investigation

Evidence-Linking Solution:

Claim-level audio timestamps prove medical necessity and support E/M level. Practices report avoiding $50K-$200K downcoding per audit cycle.

Commercial Payer Audits

Medium Frequency

Common Audit Focus Areas:

  • Prior authorization compliance
  • Network billing accuracy
  • Procedure medical necessity
  • Fraud prevention investigations

Evidence-Linking Solution:

Audio proof of patient conversation, informed consent, and clinical decision-making. Practices report reducing documentation requests significantly.

Workers' Comp Audits

Medium Frequency

Common Audit Focus Areas:

  • Work-relatedness verification
  • Treatment necessity
  • Causation documentation
  • Maximum medical improvement

Evidence-Linking Solution:

Timestamped audio of injury history, functional assessment, and work capacity discussions. Practices report reducing consultant costs significantly.

Emergency Medicine Liability

High-Risk Specialty Frequency

Common Audit Focus Areas:

  • Standard of care documentation
  • Informed consent for procedures
  • Clinical decision-making rationale
  • Time-sensitive interventions

Evidence-Linking Solution:

7-year audio retention provides complete encounter record for malpractice defense. Every clinical decision is timestamped.

Readmission Audits

Medium Frequency

Common Audit Focus Areas:

  • Discharge planning documentation
  • Transitional care coordination
  • Patient education on follow-up
  • Post-discharge care instructions

Evidence-Linking Solution:

Audio evidence of discharge instructions, follow-up planning, and patient understanding. Protect transitional care management revenue.

High-Risk Specialty Audits

Specialty-Dependent Frequency

Common Audit Focus Areas:

  • Complex procedure documentation
  • Specialty-specific E/M coding
  • Advanced imaging medical necessity
  • Surgical decision-making rationale

Evidence-Linking Solution:

Specialty-specific clinical reasoning captured in timestamped audio. Defend complex cases with exact conversation timestamps.

Real-World Case Study: 94% Audit Success Rate

35-Provider Multi-Specialty Group (Southeast)

The Problem

Receiving 40-50 audits annually, spending 600+ hours on manual audit response, $180K in denied claims

Audit Types: Medicare RAC, commercial payer, quality measure audits

The Implementation

Deployed OrbDoc evidence-linking across all providers

RESULTS
Audit Response Time
Before: 15-30 hours
After: 60-90 minutes
95% reduction
Audit Success Rate
Before: 72%
After: 94%
+22 percentage points
Denied Claims Recovery
Before: $180K lost
After: $169K recovered
94% recovery
Compliance Officer Time
Before: Full-time audit response
After: 20% time on audits
80% time freed

"Evidence-linking changed our audit defense from reactive panic to proactive confidence. We can now prove medical necessity for any claim in under 2 minutes."

— Director of Revenue Cycle, Multi-Specialty Group

TOTAL ANNUAL VALUE

$169K recovered + 480 hours saved annually = $394K total value

Calculate Your Audit Defense ROI

Current Audit Costs

Audits per year: 40-50
Hours per audit: 15-30 hours
Compliance officer rate: $75/hour
Physician time for reconstruction: $250/hour
Annual Audit Cost: $225K-$450K

With Evidence-Linking

Audits per year: 40-50 (same)
Hours per audit: 1-1.5 hours
No physician time needed: $0
Higher success rate: +$150K recovered
Annual Audit Cost: $30K-$56K

Annual Savings + Recovery:

$345K-$564K

Time savings + improved audit success rate

Frequently Asked Questions

What is evidence-linking technology?

Evidence-linking automatically timestamps and links audio segments to specific billing codes and clinical documentation. For any claim, you can instantly retrieve the exact audio proof of what was discussed, examined, or decided during the patient encounter.

How long does OrbDoc retain audio for audit defense?

7 years of HIPAA-compliant audio retention, meeting Medicare and Medicaid audit requirements. All audio is encrypted at rest and in transit with geographically redundant backup storage.

Can evidence-linking really reduce audit response time to 60 seconds?

Yes. With one-click audit response package generation, you can pull claim-level audio proof in under 60 seconds. Our case study showed a 35-provider practice reduced audit response from 15-30 hours to 60-90 minutes with 94% success rate.

What types of audits does evidence-linking help with?

Medicare RAC audits, commercial payer audits, quality measure audits (HEDIS, MIPS), and malpractice defense. Evidence-linking provides timestamped audio proof for medical necessity, E/M coding levels, procedure documentation, and clinical decision-making.

Is the audio evidence admissible for audit appeals?

Yes. Audio evidence is widely accepted by payers as documentation of what occurred during patient encounters. OrbDoc provides audit trails showing when audio was captured and accessed, with enterprise-grade certified infrastructure ensuring integrity.

"Physicians using evidence-linking report responding to 20-claim RAC audits in 2 hours instead of 2 weeks. Claims are upheld with timestamped audio evidence backing every code."

Solo Family Practice Physician

18 years practicing

Audit Defense Revenue Protection

$50K-$500K

Downcoding Avoided

Prove medical necessity with timestamped audio

$10K-$50K

Consultant Costs Eliminated

In-house 60-second audit response capability

480-780 hours

Staff Time Savings

95% reduction in audit response time annually

Total Annual Audit Defense Value: $345K-$564K

For practices facing 40-50 audits annually

Defend Audits with Evidence-Linking

60-second audit response with claim-level audio timestamps. Avoid downcoding with timestamped proof.