Medical Coding Audits are a Must for your Practice

Posted by Dave Cowley on Nov 20, 2017 3:48:49 PM

The concept is quite simple: Determine what is wrong with the patient, and then document what you do about it. As simple as it may seem, providers all across America struggle with this highly impactful piece of the business. Revenue and regulatory compliance are two of the most discussed topics of impact.  While those two factors are of the upmost importance submitting clean claims remains one of the most important parts of any providers clinic. Documention Improvement.png

Where do you start whether you are a physician, administrator, or an integral part within the revenue cycle?  Below are three very important points to consider:

Denials and deficiencies within the documentation  This requires a clear cut process that staff and provider should be clear on. Most EHR systems have the ability to query documentation and make sure you are compliant and documenting properly. You would be wise to scrub data and make sure claims go in clean to reduce denials. 

Retrospective coding audits  Perhaps the most important thing not being done in most practices today. Chances are you have third party coding reviews built into your mandatory compliance plan. According to a 20 year healthcare CEO, nearly 90% of these reviews are not being performed. Time and money are two components that lead to lack of compliance. Code Quick performs coding reviews that are an affordable and timely audit. A baseline review can cost as little as $40 and take only 5 minutes of your time. Really, there should never be an excuse, especially when the return can be so rewarding.  Reviews are important to uncover whether all required information for coordination of care and billing support is captured. 

CDI and Education We have written on both of these topics separately in the past. The importance of education and clinical documentation is paramount to getting clean claims out the door. Everything hinges on what the provider says happens in during the encounter with the patient. The coding is only as good as the documentation. MIPS, MACRA, E/M levels, ongoing ICD-10 education, patient experience, and of course documenting all of it clearly and completely.  We all know the difficulties and the struggle with training a busy provider.  If a plan and strategy is mutually agreed upon it will be much more effective when it is time to convey important details. Often times this requires outside help or influence, and many organizations benefit from third party style educational formats.

A few impacts of improved documentation include:

  •       Improved communication between your provider and revenue cycle staff
  •       Fewer claim denials/rejections
  •       Increased reimbursement (especially in the area of risk adjustment coding (HCC) and quality improvement programs like MIPS/MACRA)
  •       Better overall continuity of care and patient quality measures
  •       Fewer physician queries = less administrative time for providers
  •       Increased coder productivity = bills out the door more quickly

And finally, improved documentation of patient conditions and treatments allows for better visibility into the health of patients within our healthcare system.  Better visibility means better and more valuable analytic's for population health management, disease tracking and treatment “best practices”, and development of strategies for earlier intervention and improved outcomes.



About Code Quick

If you find yourself in need of expert medical coding help, this is the easiest way to get it. Code Quick is a technology enabled medical coding engine aimed to help small physician practices maximize their reimbursement. Get pricing in 30 seconds, get your records uploaded in 5 minutes and have everything back within 48 hours. Medical Coding done quick!


Try it Out!


Topics: revenue cycle management, Medical Practice Improvement, CDI, medical audits, coding review, education