Conducting regular coding audits and education are essential components to a healthy compliance program. Coding audits are hands down one of the best investments any practice, hospital, or health system can make. The return on investment (ROI) is infinite. And with ADRs, payer audits, and RAC audits on the rise, you simply cannot afford to ignore this area any longer. I am shocked by how many professionals remain unaware that regular audits are mandated by the Patient Protection and Affordable Care Act (PPACA). Coding audits create visibility into the operational and financial health of any organization and can reveal so much more than just coding and reimbursement issues.
Coding Audits: How they directly affect the success of your organization
Originally posted on YES HIM Consulting
By: YES HIM Consulting Team
When considering the constantly evolving and ever-changing coding landscape of today, efficient coding audit practices have become a crucial and necessary step in what healthcare organizations must do to remain compliant and profitable. If your organization is struggling to properly and accurately evaluate its coding procedures, now is the time to take the essential step of seeking an independent entity to conduct regular coding audits. The benefits of conducting a monthly coding audit for your team can save your organization a substantial amount of work, time and money. But above all else, you will have peace of mind in knowing that your coders are maintaining high compliance standards and accuracy.
Making the transition from an annual external coding audit program to an ongoing periodic review increases costs for healthcare provider organizations. Periodic and consistent audits also yield a stronger return on investment. Moreover, audits can be customized to address the organization’s specific needs—which usually vary from month to month (journal.ahima.org, 2017).
This also holds true when considering the fact that performing these audits internally can cause a sort of “provider burnout”, where the execution of these audits becomes too monotonous, leading to inaccurate results. To quote Karen Youmans, President and CEO of YES HIM Consulting, “Some providers have become too routine and complacent.” Having an outside entity to conduct facilities’ coding audits could be used in more ways than just the auditing. As Karen Youmans states, “…using the expertise of consultants to re-educate coders and give presentations to doctors on ways to improve documentation” is a great benefit that goes beyond the auditing itself, (healthdatamanagement.com, 2018). A fresh take or a fresh pair of eyes from external consultants and auditing experts can help providers pinpoint areas of concern that may have been overlooked otherwise.
Take into concern these 3 main benefits of conducting monthly coding audits:
Training and Coder Development: One thing is inevitable; coding is constantly changing. It is because of this fact that it is extremely important for every member of your coding team to change and grow with it. No matter how seasoned your coders may be, continuously learning, sharpening their skills and developing new skills will ensure that your team performs at the best of their abilities.
Consistency and Compliance: Outsourcing your coding auditing needs to an experienced 3rd party will ensure that your audits are completed consistently and accurately, without the concern of any changes that may occur internally within your organization. This also gives providers peace of mind that their audits will maintain compliance with all lawful regulations and protocols.
CDI Improvement: Coding audits provide a detailed look at what areas your team already has a good grasp on and covers efficiently, and what areas have room for improvement. Missed cases, recording errors, and incorrect codes are all areas that can be identified and improved through the use of an external coding audit.