While many providers might view coding audits as a necessary evil, an effective auditing program yields many distinct benefits. Given the intricate nature of coding rules and the myriad ways they can influence an organisation’s financial performance for better or worse code auditing makes a great deal of sense.
Coding audits are designed to find mistakes. There is a great incentive for healthcare providers to conduct their own audits instead of waiting for regulators or healthcare payers to find mistakes for them. Those kinds of audits could result in financial penalties.
Why Audit at All?
As providers navigate ever increasing revenue cycle complexity,
What is the virtue of expending effort and dollars on an audit of coding?
Medical coding is characterized by thousands of rules and interdependencies. Small details in the documentation can have meaningful impacts on the ascribed coding, and thus material impacts on the appropriate reimbursement for the encounter.
The goal of coding audits should be to identify problems and create action plans to fix those problems. The result should be a more secure revenue stream.
- Coding audits are valuable mechanisms to identify common denial areas.
- Coding complications should be caught before a patient is discharged.
- Use audit results to target education toward specific medical coders.
- Computer assisted coding (CAC) and other technological aids should be considered to keep accuracy and productivity high.
- Keep auditing.
Coding audits are opportunities for more than identifying mistakes. They can help improve processes and boost the expertise of the coding staff.