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Audits Offer Fix for Poor Coding Compliance, Lagging Reimbursement

Audits Offer Fix for Poor Coding Compliance, Lagging Reimbursement

THE EVER-INCREASING complexity of healthcare is driving the need for coding quality and compliance programs. Given the transition to ICD-10, advancements in treatments and procedures, a move to quality reporting, and evolving regulations with potentially lofty penalties, the lost reimbursement at stake as the result of poor coding is driving more providers to intensify their coding audit programs.

The trend among large providers is a wave of both random and targeted audits at varying stages of the revenue cycle—from pre-bill to post-bill analysis of key issues ranging from denials to specifics such as transfer DRGs.

Topics: Quality, Audit, Health Information Management

The Future of HIM Quality Audits

5 REASONS WHY CODING & DOCUMENTATION AUDITS ARE MORE IMPORTANT THAN EVER

All health information management (HIM) leaders know that coding quality audits are critical. We can all agree the consequences of substandard coding – lost revenue, increased denials, and greater compliance risk – make the development of a comprehensive coding audit program a priority for healthcare providers of all sizes. Unfortunately, scarce resources and conflicting priorities force many providers to compromise their compliance programs. But now more than ever, audits of coding and documentation quality are critical to the success of healthcare providers.

Topics: Quality, Audit, Health Information Management, ICD-10

CAN YOU CREATE AN INVINCIBLE MEDICAL CODING PROGRAM?

The importance of accuracy and compliance in today's coding environment cannot be overstated. High-quality coding is always a priority – but is there a way to make coding impervious to challenges? Unfortunately, the answer is “NO.”  There is no magic wand that can be waived, spell that can be cast, or cape that you can use to ensure your coding program is invincible.  The fact of the matter is that no two medical records are documented in the same manner and most coding clinics can be interpreted differently.

Topics: Education, Coding, Audit

Maximizing resources for ICD-10 coding audits

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by Julia Hammerman, Director of Education and Compliance, and Sam Champagnie, Senior Director, HIM Operations

The newness and specificity of ICD-10 ushered in a stronger focus on clinical coding audits. From internal reviews to external coding audits, healthcare organiza­tions nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind. Diagno­sis-related group (DRG) validation audits under ICD-10 have also become more strategic to realize revenue cycle success.

Topics: Coding, Audit

3 Tips to Justify Your Need for Auditing Resources

In her blog post, "2 Things HIM Leaders Wish Their Revenue Cycle Peers Knew," Andrea Romero, SVP of HIM Operations at himagine solutions, challenged HIM leaders to become more visible within the revenue cycle function to help improve awareness of the importance and challenges associated with the HIM department. This prompted me to reflect on some of the feedback I receive from clients who are interested in utilizing companies like himagine for audit services. In many cases the client has a desire to go beyond a traditional and episodic compliance audit by developing a more comprehensive approach that addresses individual coder performance on an ongoing basis. Inevitably, this desire is tempered by the fact the HIM department does not have the funds budgeted to initiate such a program and the thought of achieving approval from the senior levels of the revenue cycle organization for this funding seems overwhelming.

Topics: Audit

2 key questions to optimize coding audits

In our soon to be released second annual HIM Benchmark Report, 70% of HIM leaders indicated they increased auditing efforts in 2016 and a whopping 96% projected to maintain or increase this level of auditing in 2017.

Topics: Coding, Audit, Quality

With the Right Preparation ICD-10 Updates Can Increase Revenue

The next wave of the ICD-10 transition may help Organizations increase revenue through higher level of specificity in claim submission.  The key to this success is driven by continuous monitoring of coding accuracy.

Topics: ICD-10, Audit, Coding

Case Study: The Impact of Coder Performance Improvement

For HIM professionals and the providers they work for, ongoing education plays an important role in data accuracy.  Coding guidelines are frequently updated and coders must adapt to new rules while meeting quality and productivity standards.  With just a few months to go before the continued expansion of the ICD-10 coding set, providers must think strategically about implementing solutions that will minimize coding errors while maximizing reimbursement.

Topics: Audit, Quality, Coding