One of the top defenses against risk, exposure and low reimbursements is a strong medical coding quality audit program. With this program, hospitals and healthcare organizations can achieve coding and financial success, quality outcomes and avoid costly penalties. The program identifies areas of opportunity for risk and/or areas of concern while also identifying areas that are functioning properly. Areas of risk are monitored more frequently and in turn, this improves the desired outcomes that can strengthen the overall success of your organization’s revenue cycle and bottom line.
Building a Medical Coding Audit Program
The integration of a coding audit program within a healthcare organization allows access to the objective of the audit outcome and accurately captures the audit details. The audience and overall deliverable are also identified to productively conduct the audit.
The goal is to ensure timely and accurate medical coding by preventing delayed reimbursement with efficient coding turnaround. These coding best practices and efficiency boosts help prevent backlogs while improving denial management and missed revenue. With Savista’s proven medical coding audit program, your health system can be confident that codes will accurately reflect treatment, diagnosis, and severity while avoiding penalties and recoupments stemming from previous instances of upcoding/improper coding.
Questions to Ask Prior to Beginning the Medical Coding Audit
- What is the scope of the audit?
- Who are the stakeholders?
- What is the data to be used for?
Choosing a Sample Audit
- Random – Look for areas of improvement.
- Targeted – Take a deeper dive into areas of suspected or known risk.
- Audit size – Small insufficient data and large skews data bog down the process.
Choosing a Sample Audit
- Audit size—Small insufficient data and large skews data bog down the process
- Educate within areas of deficiency, if needed
- Coding applied by electronic health record (EHR) systems are not always accurate. It is imperative the EHR systems are updated annually with the new ICD-10 code sets.
Have a question for an experienced medical coding specialist from Savista? Click here.
Angela Knight is a quality assurance manager, quality assurance supervisor and a quality assurance lead.
About Savista
Savista is a prominent provider of healthcare revenue cycle management services. Savista partners with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities. We integrate knowledge and expertise of the revenue cycle to provide financial and operational performance benefits for healthcare organizations of any size. Our global organization of 4,000 colleagues partners with more than 330 US-based healthcare clients, delivering custom solutions to help solve their business challenges. To learn more about Savista and our value-building solutions, visit SavistaRCM.com.
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