Improve your Coding Accuracy with professional Coding Audits
What do you mean by Coding Audit ?
A coding audit is known as a review of coding done by the medical coders in the medical office, by reviewing all patient’s medical records. It usually targets diagnosis and procedural code as it was determined by the physician’s documentation for accuracy.
It is a part of medical coding. If you don’t know what medical coding is then, don’t worry, we have got you covered.
Medical coding is a process of transformation of Healthcare diagnosis, Medical Services and equipment occurs into Universal medical alphanumeric codes. The diagnosis reports are taken from Medical records such as transcription of physicians notes, basically medical coding professional help to ensure that the codes are applied correctly during the billing process that usually include assigning the proper codes and to create a claim that can be paid by insurance carriers.
So, this is known as medical coding. Now, let us get back to the topic and discuss the scope of Coding Audit.
What is the scope of Coding Audit ?
When a coding auditor is working, it usually looks at many factors regarding medical office claims, they also look on other things including :
- Proper use of CPT codes.
- Determining the correct places of service.
- Looking at missing or wrong use of the modifiers.
- To identify the incorrect diagnosis.
- To identify coding accuracy needs for documentation, for trends, and also deficiencies, if they are any.
- Verification of a support document which is accurate and adequate for describing care that is provided to the patient.
- To determine, if the services are necessary and reasonable or not.
So, this was the scope of medical audits. Now let us look into why it is important ?
Importance of coding Audits ?
Coding audits are very important for us as well as for hospitals. The reasons are :
- It helps to ensure your coding practices follow some acceptable and up-to-date standards.
- It helps you to compare your coding practice with other medical coders practice’s and helps you to improve.
- It helps to identify the areas of revenue lost.
- It also helps medical coders to identify areas of compliance concerns.
Whether your coding audit is good or worse, you have to improve in all cases. Betterment of coding audits is the ultimate goal of the organisation . The audit process gives an opportunity to identify and prevent compliance and payment issues.
Benefits of Coding Audits :
There are internal as well as external benefits of Coding Audits. Let’s start with internal audits.
Internal Benefits :
- It creates opportunities to level up your staff : It is one of the most important boons or benefits of regular coding audits as it is giving the opportunity to educate an organization’s staff. Staff is the most important and the primary key to an organization’s success. A coding audit features a case-by-case analysis of all the findings. Frequently done audits help to provide the feedback that you would need to identify the education opportunities and to devise a plan to implement them in an efficient way.
- It helps to code to the right level : If you are doing medical coding then, it must be accurate, precise, and always up to the mark. Coding Audits helps to identify those coding practices that affect your reimbursement, just like under-coding services. Now, coding at the right level means that you are getting paid exactly the same amount of the amount of work you are doing.
- It helps to maximize reimbursement : The rejections that you face slows you down and costs you a lot of money.
These types of benefits ensure that you upgrade your staff and use their time efficiently and effectively , and the result would be that your cash flow is maximized. Doing coding audits regularly reduces over and underpayments,and ultimately maximize your profit.
External benefits :
Now, let us discuss some external benefits also.
- It helps to maintain compliance : Coding audits helps the organization in identifying new laws and regulations, payer rules, and other types of issues that can affect your specialties. It helps you to apply new codes and helps to change everything from the beginning.
The OIG system requires a minimum of one annual audit so as to maintain compliance. It is sufficiently enough to satisfy the requirement.
- It helps to reduce rejections and denials : With regular audit coding, it becomes easier to sustain and reduce the aspects of rejections as well as denials by the customers or the patients. Claims may be rejected and denied for inaccuracies, and so if we perform regular coding audits then, there will be very less inaccuracies.
- It helps to prevent fines and investigations : regular auditing is very necessary as if your coding problems are very much and the payers find many irregularities in their documentation then, your practice can be flagged for investigation, whether you are right or wrong. The investigation officers always look out for the frauds done by the medical coders. If you get into these types of investigations then let me tell you that they are stressful and costly.
Now, let us look on to the coding audit process.
Process for Coding Audit :
- Recognise that your coding auditor are your partners and not just your employees.
- Then, identify the auditor.
- Then, establish the scope for your coding audit.
- Always keep looking for irregularities.
- Find the unrelated codes in the documents.
- Make improvement plans continuously.
Now, let us look on to the types of coding audit.
Different types of Coding Audits :
- Post-bill coding audit : It looks at submitted claims.
- Pre-bill coding audit : It looks at coded claims that are not yet billed.
So, this was all about Coding Audit.
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