It’s an ideal industry practice that everyone who does medical coding (including physicians who code their own work) should have a periodic audit or ‘peer review’ to assure that their skill levels remain high and accurate. Accurate medical coding has a crucial role in healthcare information management and overall quality of care.
Although Medical Billers and Coders (MBC) provide complete assistance for your practice’s coding, we recognize that this is not always the desired solution for everyone. Every practice has unique coding requirements, one size does not fit all.
Frequent internal or external audits can reveal inaccuracy issues, such as outdated codes or even fraudulent billing. These audits provide a quality assurance process that helps organizations obtain proper reimbursement and maintain regulatory compliance.
Let’s understand the importance of medical coding audits and how they can improve your practice’s coding accuracy:
Why Conduct Medical Coding Audit?
- As mentioned earlier, leading agencies like OIG and CMS recommend that all providers should review their coding by an outside independent party who has expertise in that clinical specialty, on a regular basis. This review will not only ensure its accuracy and compliance but also will provide unbiased independent evaluation to the provider’s coding. This unbiased independent evaluation will ensure that coding regulatory updates (i.e., new/modified codes, new/modified coding edits and bundling rules, etc.) are being incorporated into the provider’s coding protocols. For any practice coding staff changes which might affect coding as specialty coding skills vary from individual to individual. For continuous quality improvement, you have to prevent errors from becoming ‘institutionalized.’
- When a claim is submitted, federal and state agencies will make, the physician and group practice responsible for the information entered on that claim including any billing irregularities. CMS has independent companies ‘RAC’ (Recovery Audit Contractors) to review the accuracy of claims on a contingency percentage. In case of such audits, having independent coding evaluation helps prevent and reduce potential legal and financial compliance exposure. On the plus side, such reviews from a third party can be treated as a teaching tool for providers and coding/billing staff.
- Such reviews can also be useful in the identification of opportunities to optimize reimbursement. Accuracy or compliance is not solely the output of such reviews. Mistakes in coding or misconceptions about some CPTS could result into lost charges and undervalued services. Such lost charges over a period of time can accumulate and can affect the financial health of your practice. No such agency or any private payer will ever send a payment more than the billed amount. Such audit reports address this by identifying missed charges and undervalued services.
- Medical coding accuracy is not only dependent on medical coders, who can only use the documentation they are given. If the provider generates documentation with missing or undecipherable details, the medical coding is going to be inaccurate. The purpose of coding is to accurately report what happened during the provider-patient encounter. The codes must reflect the contents of the doctors’ medical records. They are the legal source documents; nurses’ notes, technicians’ notes, and the rest of the chart are secondary to the physicians’ notes and reports. An integral component of our coding accuracy review is to identify any documentation deficiencies or discrepancies in the physicians’ reports that we observe. Our feedback helps our clients improve the quality of their medical records, which we feel leads to improved patient care, and also gives the coders more complete and thorough documentation from which to code.
How Often You Should Have an Audit?
How often to audit medical coding can depend on any number of factors, including the size of the organization, the rate of staff turnover, and regulatory updates. The experts recommend an external coding audit at least once a year, but many healthcare facilities commit to monthly external coding audits to reap as much benefit as possible.
Monthly coding audits help healthcare organizations catch errors more frequently, which means they can recapture more revenue and rectify the errors resulting in lost revenue. The insights gained from monthly audits can be used to keep medical coders up to date on the latest regulatory requirements and help them avoid common errors. The results of monthly audits can also be used as an important tool in onboarding new coders.
About Medical Billers and Coders
We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.
FAQs
1. Why should healthcare providers conduct regular medical coding audits?
Regular audits ensure accurate coding, and compliance with regulations, and identify opportunities to optimize reimbursement, preventing errors and reducing legal exposure.
2. How often should medical coding audits be conducted?
Experts recommend at least one external coding audit per year, with many organizations opting for monthly audits to catch errors more frequently and improve revenue recovery.
3. How do coding audits improve reimbursement opportunities?
Audits identify missed charges and undervalued services, ensuring that healthcare providers receive proper compensation for the services they deliver, and avoiding revenue loss over time.
4. What is the role of documentation in coding accuracy?
Accurate coding relies on clear and complete documentation. Inaccurate or incomplete physician notes can lead to coding errors, so improving documentation quality is crucial for accurate billing.
5. How do external audits benefit medical coders?
External audits help coders stay updated on regulatory changes, identify common errors, and provide valuable feedback, improving their coding accuracy and knowledge over time.
