Stay Coding Compliant with Medical Audits

Basics of Coding Compliant with Medical Audits

A coding audit is a review of a medical office’s coding practices conducted by reviewing patient medical records. Medical record audits target and evaluates procedural and diagnosis code selection as determined by physician documentation for completeness and accuracy. Medical audits cover: assessing the proper use of CPT codes; determining the correct places of service; finding out missing and/or incorrect use of modifiers; detecting incorrect diagnoses; documentation accuracy; identifying any bundling or cluster issues.  

Accurate coding by Physicians is critical to getting paid for the services provided and for avoiding external audits by Medicare and other private Payers. The easiest and probably best way is to audit a select sample of charts. MedicalBillersandCoders (MBC) provides coding compliance audits to physicians which enables them to make corrections before their coding is questioned by the payers. Our coding audit services are designed to help you maintain compliance with different industry standards. Our coding audit services also enable the providers to fully code the encounters which may otherwise have been down-coded. 

Benefits of Medical Coding Compliance Audit

  • Maintain compliance: In COVID-19 pandemic coding guidelines are being updated continuously, a new set of reimbursement policies are introduced constantly, so staying compliant is challenging. Coding audits identify new laws, regulations, payer rules, and other issues that are applicable to your medical specialties. The audit will help you apply new codes and changes correctly from the beginning. The Office of Inspector General (OIG) also requires at least an annual audit to maintain compliance. Conducting audits on a quarterly or a monthly basis helps avoid lapses in compliance early.
  • Reduce claim rejections and denials: Periodic coding audits result in more accurate medical coding resulting in fewer rejections and denials. Major reasons for claim denial are insufficient documentation, wrong procedure, and diagnosis codes, which get covered in coding audits. Coding audits at regular intervals of time provide a great way to identify and correct issues so that more claims can be paid on time and in full. Coding at the right level means that are you are paid correctly and not settling for less than you are owed. Your practice deserves to receive the correct reimbursement from private as well as government payers.
  • Educate your staff: Perhaps the most important benefit of regular coding audits is having the opportunity to educate your staff. Medical coding accuracy evaluations should be included in a continuous quality improvement program. Frequent audits provide the feedback you need to identify education opportunities and devise a plan to implement them.
  • Maximize reimbursement: Fewer mistakes by undertrained or overworked coding staff result in more claims getting paid. Rejections and denials slow you down and cost you money. Improving the quality of your coding through regular coding audits keeps your office running efficiently. These benefits ensure that you use your staff’s time efficiently, and cash flow is maximized. Regular coding audits reduce overpayments and underpayments, lower the rate of rejections and denials, keep your practice compliant, encourage your staff to focus on quality coding, and ultimately maximize your profit.
  • Prevent payer audit/investigations: If coding problems persist and payers find irregularities then your practice can be flagged for investigation. The investigation looks for potential fraud by the practice. These investigations are stressful and costly. If fines are levied, serious financial consequences may ensue. Regular coding audits educate and improve your practice and ensure that your practice will not be flagged for fraud, waste, or abuse.

Reduce Compliance Risk By Implementing Regular Coding Audits

To Summarize

The purpose medical coding audit is to improve coding compliance for your practice. Audit reports would be discussed to review internal coding methodologies and methods for calculating error rates, numbers and rates of issues, trends, and more. This report will provide an excellent learning opportunity for staff. The audit report identifies the root cause of some of your coding discrepancies. Regardless of the areas of improvement identified in a particular audit, implementing the changes make your practice run more efficiently.

MedicalBillersandCoders (MBC) is one of the leading revenue cycle service providers. Along with overall revenue cycle services, we also help practices in coding compliance audits. We utilize current AMA and industry coding guidelines, Correct Coding Initiative (CCI)edits, CMS (Medicare) specialty-wise coding conventions and practices. Our medical coding audit services also include a case-by-case analysis of our findings. Our medical coding accuracy audits are designed to be part of a continuous quality improvement program. It gives the providers and surgical coders the feedback they need to more accurately code the patient-care services. To know more about our billing and coding services, contact us at 888-357-3226