The Importance of Medical Coding Audits in Healthcare

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Importance of Medical Coding Audit
Its an ideal industry practice that everyone who
does medical coding (including physicians who
code their own work) should have a periodic audit
or peer review to assure that their skill
levels remain high and accurate. Accurate medical
coding has a crucial role in healthcare
information management and overall quality of
care. Although Medical Billers and Coders
(MBC) provide complete assistance for your
practices coding, we recognize that this is not
always the desired solution for everyone. Every
practice has unique coding requirements, one size
does not fit all. Frequent internal or external
audits can reveal inaccuracy issues, such as
outdated codes or even fraudulent billing. These
audits provide a quality assurance process that
helps organizations obtain proper reimbursement
and maintain regulatory compliance. Lets
understand the importance of medical
coding audits and how they can improve your
practices coding accuracy Why Conduct Medical
Coding Audit?
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Importance of Medical Coding Audit

• As mentioned earlier, leading agencies like OIG
  and CMS recommend that all providers should
  review their coding by an outside independent
  party who has expertise in that clinical
  specialty, on a regular basis. This review will
  not only ensure its accuracy and compliance but
  also will provide unbiased independent evaluation
  to the providers coding. This unbiased
  independent evaluation will ensure that coding
  regulatory updates (i.e., new/modified codes,
  new/modified coding edits and bundling rules,
  etc.) are being incorporated into the providers
  coding protocols. For any practice coding staff
  changes which might affect coding as specialty
  coding skills vary from individual to individual.
  For continuous quality improvement, you have to
  prevent errors from becoming institutionalized.
• When a claim is submitted, federal and state
  agencies will make, the physician and group
  practice responsible for the information entered
  on that claim including any billing
  irregularities. CMS has independent companies
  RAC (Recovery Audit Contractors) to review the
  accuracy of claims on a contingency percentage.
  In case of such audits, having independent coding
  evaluation helps prevent and reduce potential
  legal and financial compliance exposure. On the
  plus side, such reviews from a third party can be
  treated as a teaching tool for providers and
  coding/billing staff.
• Such reviews can also be useful in the
  identification of opportunities to optimize
  reimbursement. Accuracy or compliance is not
  solely the output of such reviews. Mistakes in
  coding or misconceptions about some CPTS could
  result into lost charges and undervalued
  services. Such lost charges over a period of time
  can

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Importance of Medical Coding Audit

• accumulate and can affect the financial health of
  your practice. No such agency or any private
  payer will ever send a payment more than the
  billed amount. Such audit reports address this by
  identifying missed charges and undervalued
  services.
• Medical coding accuracy is not only dependent on
  medical coders, who can only use the
  documentation they are given. If the provider
  generates documentation with missing or
  undecipherable details, the medical coding is
  going to be inaccurate. The purpose of coding is
  to accurately report what happened during the
  provider-patient encounter. The codes must
  reflect the contents of the doctors medical
  records. They are the legal source documents
  nurses notes, technicians notes, and the rest
  of the chart are secondary to the physicians
  notes and reports. An integral component of our
  coding accuracy review is to identify any
  documentation deficiencies or discrepancies in
  the physicians reports that we observe. Our
  feedback helps our clients improve the quality of
  their medical records, which we feel leads to
  improved patient care, and also gives the coders
  more complete and thorough documentation from
  which to code.

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Importance of Medical Coding Audit
How Often You Should Have an Audit? How often to
audit medical coding can depend on any number of
factors, including the size of the organization,
the rate of staff turnover, and regulatory
updates. The experts recommend an external coding
audit at least once a year, but many healthcare
facilities commit to monthly external coding
audits to reap as much benefit as
possible. Monthly coding audits help healthcare
organizations catch errors more frequently, which
means they can recapture more revenue and rectify
the errors resulting in lost revenue. The
insights gained from monthly audits can be used
to keep medical coders up to date on the latest
regulatory requirements and help them avoid
common errors. The results of monthly audits can
also be used as an important tool in onboarding
new coders. About Medical Billers and Coders We
are catering to more than 40 specialties, Medical
Billers and Coders (MBC) is proficient in
handling services that range from revenue cycle
management to ICD-10 testing solutions. The main
goal of our organization is to assist physicians
looking for billers and coders.
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Importance of Medical Coding Audit
FAQs 1. Why should healthcare providers conduct
regular medical coding audits? Regular audits
ensure accurate coding, and compliance
with regulations, and identify opportunities to
optimize reimbursement, preventing errors and
reducing legal exposure. 2. How often should
medical coding audits be conducted? Experts
recommend at least one external coding audit per
year, with many organizations opting for monthly
audits to catch errors more frequently and
improve revenue recovery. 3. How do coding
audits improve reimbursement opportunities? Audits
 identify missed charges and undervalued
services, ensuring that healthcare providers
receive proper compensation for the services they
deliver, and avoiding revenue loss over time. 4.
What is the role of documentation in coding
accuracy? Accurate coding relies on clear and
complete documentation. Inaccurate or incomplete
physician notes can lead to coding errors, so
improving documentation quality is crucial for
accurate billing.
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Importance of Medical Coding Audit
5. How do external audits benefit medical
coders? External audits help coders stay updated
on regulatory changes, identify common errors,
and provide valuable feedback, improving
their coding accuracy and knowledge over time.