What Medical Coding Audit is and Its Value

Medical coding has gone through waves of change from ICD-9 to ICD-10 last decade and is already looking ahead to ICD-11. But even within ICD-10, there are new medical codes constantly added or changed each year.  This has been especially true in the face of COVID and the need for new medical codes to address treatments and vaccinations related to COVID.

Medical Coding Audit Explained

By identifying under coding or overcoming errors through medical coding auditing tools and devising remedial actions in order to get rid of them, the audit will serve an important role in the compliance plan of an organization. A medical coding audit offers mechanisms to:

  • Defend against payment and federal audits
  • Ascertain earned revenue is captured
  • Optimize revenue cycle management
  • Educate providers on the documentation regulations
  • Review the value-based care and quality of care offered to patients

What Are the Basics of Medical Coding Audit?

Medical coding experts usually review the procedure codes and diagnoses offered by a physician’s notes and ancillary testing results.

Immediately after they are reviewed, coders ascertain that they are applied well during the billing process, which might include creating claims, assigning the right codes, and abstracting details from documentation to ensure insurance carriers pay healthcare providers the right amount.

Goals for Medical Coding Audit

Medical coding audit needs to include a sample of patient encounters as billed and codes. In order to design a coding audit, you will need to identify some strategic initiatives, like, the sample size, the prevalence of diseases, validation of a coded claim, and adherence to procedures to ascertain compliance.

A coding audit should be carried out using internal auditors or an outsourced company or person who is credentialed with AAPC or AHIMA at auditing medical coding and the documentation of medical records.

The Value

Carrying out an annual medical coding audit is a compliance requirement. The CMS (Centers for Medicare and Medicaid) encourages all healthcare providers to have their coding reviewed by a reliable and independent party.

Regular medical coding audit comes with numerous benefits, which all revolve around improving how your medical practice works. Some of these benefits include:

  • Reduce fraud
  • Increase compliance
  • Protect your medical practice’s bottom line
  • Improve accuracy
  • Offer coder education opportunities

Final Touches!

Medical coding audit serves as a vital tool in any compliance program of all healthcare organizations or hospitals. It helps illuminate all the potential areas for corrections, which may then protect revenue and minimize payer denials.

Performing regular medical coding audits will also help enhance data integrity, increase communication in the organization, and provide for better clinical documentation.

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