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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.

Prior to October 2015, external ICD-9 coding audits were performed primarily for compliance purposes. Ongoing coding audit programs were rare due to the high cost of support and maintenance. However, following the implementation of ICD-10, many hospitals and health systems have stepped up their coding audit efforts. More frequent reviews are now recommended to measure coding accuracy—and for good reason. Coding accuracy has declined in ICD-10.

Data analytics has moved from IT and finance to the majority of business functions—including clinical coding. Is your organization leveraging analytics? Check out this month's HIM Scene guest blog, authored by Julia Hammerman, Director of Education and Compliance at himagine. Julia's blog explores the importance of analyzing clinical coding data to improve quality, productivity, and compliance.

Many facilities and health systems are considering creating their own "coding schools" to provide ongoing education and development opportunities for their HIM professionals to continuously improve quality and to address supply gaps for more complex coding positions. Having established programs both at BJC HealthCare and here at himagine solutions, I have a unique appreciation and understanding of the challenges associated with this endeavor. I plan to share my insights on buildling a HIM education platform in an upcoming webinar. Whether you are developing a platform from the ground up or looking to optimize your current program, I think you will find my session beneficial. I will focus on the following key areas: