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Why You Need Consistent Medical Coding Audits

If you’ve ever purchased a large piece of furniture, like a desk from IKEA, you’ll know you have to follow the diagrams step by step to assemble it. You’ll understand the sense of accomplishment when you’ve taken a pile of shapes and managed to make it into a functioning piece. You’ll also understand the troubling sense of worry when you realize that you have a few screws leftover or perhaps an extra panel that didn’t fit into the master plan.

It would be great if there was someone who could assure you that the furniture was assembled correctly and accurately and that as a high-quality piece, it would hold up for years to come. You’d know exactly what you did right, and you’d also understand where you can improve next time. Or, worst-case scenario, the person assessing your work may reveal that the desk is going to collapse, and advise that you need to hire a professional or receive training in order for future projects to succeed. In the medical coding world, that person would be a coding auditor.

If you’re not auditing your medical coding consistently and frequently today, here's how you can start.

Determine what kind of audit to complete

The size and frequency of audits can vary greatly. Audits can be individually-based or organization-wide, and they may have different purposes. For example, consistent internal audits of your coders will determine education needs within your division, while hiring an external source to audit for compliance will identify areas to improve to meet coding regulation. We’ve talked about using audits to improve your medical coding accuracy previously, but how often — and what, exactly —should you be auditing?

The more frequent the better. Internally, set your quality standards and designate a coding quality assurance specialist to assess your coders’ work. Run reports to analyze coding-related edits and denial trends, and look into other areas of your revenue cycle to identify issues on the back end that an adjustment in coding practices could help remedy. For instance, if your patients are asking questions about their EOBs related to coding, create a crosswalk between your patient representatives and coders to answer common questions. 


Reinforce what is being done right

Auditing internally with an educational intent and positive approach will provide your coders with more confidence. Confident coders are more productive, happier, and will bring more value to your organization overall. Check each of your coders’ work against your set quality standard to set a baseline. Knowing your starting point is the best way to determine the next steps and measure improvement and growth. 

Educate and assist with professional development

Implement a no-surprises methodology. Your coders should know that internal audits are taking place, that their purpose is to identify education opportunities, and that they are never intended to be punitive. One coder may only be making an occasional mistake while another may have developed poor habits over time that are affecting coding quality, yet both coders will appreciate when their errors are caught and corrected, especially when education and improvement have been previously set as a department objective. Also, make sure no coder is exempt. ICD-10 is still fairly new and has posed a learning curve to everyone — new and experienced coders — so there are plenty of opportunities to help your coders become educated on or simply more efficient with the expanded code set.

Ensure compliance

Speaking of code sets, CPT, ICD-10, and HCPCS code sets are updated and published annually so the need to audit for compliance is continual — and that’s without even mentioning the time-consuming, difficult task of keeping up with Medicare and other payers’ medical policies.

Hiring an external source to audit for coding compliance will uncover any issues with current regulations so they can be corrected or prevented proactively. An external audit will also reduce the risk of improper documentation and mistakes, minimize the risk of fraud and ensure that Medicaid and Medicare standards are being met, among other important goals.

The Bottom Line

Part of doing good business is identifying problems and resolving them quickly, so audit often and audit well — internally and externally — to ensure your coders are confident and well-educated and your entire coding operation is in compliance. This way, unlike the IKEA desk with leftover screws and panels, your coding division will have the “structural integrity” not only to hold up under regulatory scrutiny but also to positively contribute to the revenue cycle performance of your organization.

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