June 22, 2017
Quality health care is incomplete without the accuracy and completion of the medical record and the corresponding coding. To ensure the medical records are 100% accurately coded, it is important to complete a medical coding audit. Here are the top 10 reasons to conduct an external audit in 2017:
- With the increased specificity of ICD-10, your case mix index should have gone up, but many organizations experience a drop or flat line. If this is the case for your organization a DRG (Diagnosis Related Groupings) validation audit might be helpful.
- Are you up to date with current coding guidelines? There was a coding update on January 1, 2017 and it is wise to make sure that you are using correct and current codes, and not those that are outdated.
- Status update- Are you doing as well as you think you are? Maybe the last time you did an audit, there was not too much that was out of the ordinary, which is great! But if that was over a year ago, it’s time to make sure you are still doing this well.
- To protect against fraudulent claims and billing activity.
- To reveal whether there is variation from national averages due to inappropriate coding, insufficient documentation, or lost revenue.
- To help identify and correct problem areas before insurance or government payers challenge inappropriate coding.
- To help prevent governmental investigational auditors like recovery audit contractors (RACs) or zone program integrity contractors (ZPICs) from knocking at your door and asking for money to be returned.
- To remedy under coding, bad unbundling habits, and code overuse and to bill appropriately for documented procedures.
- To verify electronic health record (EHR) meaningful use readiness and to ensure there are no copy and paste issues.
- To make sure you are getting the reimbursement you deserve. Routine audits can help identify areas for revenue improvement and enhancement, many times causing the audit to be cost neutral or positive.
Once you have the results of your medical coding audit, MedKoder will be able to provide you with customized education and recommend next steps or improvements to work flow. Then, you will be able to determine problem areas and what is accountable; therefore, improving your organization’s coding processes and have financial peace of mind.