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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

Don’t Be Leery of the Physician Query – 12 Tips to Ensure Your Queries Work

According to AHIMA, a query can be a powerful communication tool used to clarify documentation in the health record and achieve accurate code assignments. Querying has become a common communication and educational tool for clinical documentation improvement (CDI) and coding departments. An effective query process aids the hospital’s compliance with billing/coding rules and serves as an educational tool for providers, CDI professionals, and coding professionals.

Topics: Quality, CDI, ICD-10, Coding, Education, HIM

Coding Quality Is Priority #1

In 2015, himagine conducted its inaugural HIM Benchmark Survey in the midst of the preparation for ICD-10. At the time, approximately 56% of respondents reported that they planned to outsource at least a portion of their coding. In our 2016 survey, 63% of respondents indicated that they outsource, making it clear that most healthcare providers currently rely on some coding vendor resources and will likely continue to work with outsourced coders going forward.

Topics: Coding, Outsourcing, Quality

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

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

Case Study: Improve Quality with Enterprise Coding

Posted by Michael DiMarco

In a previous blog post, I discussed the ways in which the current healthcare industry outsource coding model delivers a suboptimal result for hospitals.  In that piece, I highlighted some of the underlying perceptions and realities of the traditional staffing model in comparison to a managed coding solution which I believed would provide a better way for facilities to meet their outsourcing needs.  In January 2015, we launched Enterprise HIM as a solution for our clients.  One year later, we have completed our first Enterprise HIM Case study which showcases the value a well-designed and executed managed coding solution can deliver to providers.

Topics: Outsourcing, Coding, Quality