Audits of any variety don’t typically come with a positive connotation. Close inspection usually turns up a laundry list of “things you’re doing wrong.” And that’s hard to swallow — unless you’re looking to improve.

No one likes an audit. But we’ve found that auditing coders on an individual basis along with an external coding compliance audit can bring any quality issues to the forefront so they can be addressed in a timely manner. And, when done with the right intention, style, and frequency, medical coding audits will actually improve coding accuracy when feedback is given to providers and coders.

Audit for education

Partnership building among auditors, coders, and providers can pay big dividends. If both auditor and coder/provider regard audits as a time to learn, they can be mutually beneficial. Especially with providers, an auditor can learn more of the provider’s thought patterns and a greater understanding of the practice of medicine. When working with coders, attitude and mutual respect builds trust. Neither providers, coders, nor auditors know it all when it comes to the complexity of medical coding, and that’s why constant learning is vital.

Audit for quality over productivity

Speed has no merit when errors are present. No one will argue that quality and productivity are both imperative, but productivity without quality leads to denials, and worse. If you’re wondering how or why you should start auditing coders to improve quality, here are three things you should know:

1. Establish a quality assurance (QA) process with standardized measures of coding quality performance.

Your coding audit acts like a baseline indicator of coding accuracy. First and foremost, it helps you identify root causes for coding errors, but more than that, it will also point to strengths and weaknesses in your coders, and that will help you set your coder education goals.

2. Determine the frequency and style.

If you’re not doing internal coding audits at all, you know you just need to start. But “how often” is a valid question. Once a month? Quarter? Year? There is actually no right or wrong answer, but there are parameters that will help you determine what’s right for your operation. Specialties that are deemed complex may require a more frequent auditing schedule. New hires or coding a new specialty may also require a more frequent audit schedule.  The important part is determining the schedule.

Your coders should want to be audited. Seriously. It should be presented to them as a learning opportunity. Coders who are empowered — who believe that the work they do impacts the entire revenue cycle — will appreciate and even look forward to audits, because they understand they are part of something much bigger than a pile of charts or total charges at the end of each day.

Empowering your coders to do their best will contribute to organizational success.

 3. Use your QA process to onboard new coders.

No, not as a scare tactic, but as a reassurance method. We believe that even experienced coders need training and a ramp up period to learn a new specialty, work in a different system, or with previously unfamiliar payers.

When a coder is hired at MediRevv, his or her work is audited to identify and address any issues that may arise as they settle into their position. Monthly audits are performed to keep an eye on their progress. Once a coder completes three consecutive months with 95% or greater coding accuracy, the coder is promoted to “verified” coder status. From that point, quarterly quality audits continue to ensure that high standard is maintained and to provide crucial and consistent feedback to the employee.

Audit for compliance

Coding accuracy is also essential to maintaining compliance. The Medicare Strike Force recently charged 300 individuals with submitting $900 million in fraudulent bills and claims. This is the biggest health care fraud takedown in almost a decade and should serve as a reminder that accuracy (really, honesty) counts. The government takes this seriously and monitors claims to protect public health funds.

Regular external audits of coding operations help ensure compliance with regulations. The American Association of Professional Coders (AAPC) is an excellent source of information on quality assurance and auditing. Consider regular external audits when you need to:

  • Determine if day-to-day operating procedures are compliant with current regulations
  • Prevent non-compliance issues from reoccurring
  • Reduce the potential for over or underpayments and subsequent fines or sanctions
  • Reduce the risk of improper documentation and mistakes
  • Minimize risk of fraud
  • Ensure compliance with Medicaid and Medicare standards

But that’s not all. Like internal coder audits, external audits reveal opportunities for training and process improvements that will ultimately result in a more efficient coding department with fewer errors, reduced denials, and proper claim adjudication.

The true benefit to regular external audits? Peace of mind. And no surprises.

The Bottom Line

Regular audits to provide feedback, identify issues, and monitor compliance can improve the overall quality of your medical coding. Proper coding on current claims reduces the potential for edits and denials, work time to be spent productively. And, perhaps most importantly, while accuracy and compliance are good business practices, they also help to ensure timely adjudication of claims.