Independent Coding and Documentation Audits

COMPLIANCE SHOULD BE A MAJOR CONCERN FOR HEALTHCARE PROVIDERS AND THEIR STAFF.

Approximately every dollar the government spends auditing providers, the return is twenty-seven dollars. To control rising healthcare costs, the government has allocated new funding for auditing and enforcement projects. Fines can be substantial, as much as $22,000 per year.

It is essential to realize that a medical record audit will focus on procedural and diagnosis code selection as determined by the physician documentation.

Here are three important reasons to do regular Coding and Documentation Audits:

  1. Coding must match the services for the claims paid by the insurance company. Therefore, OIG Compliance requires regular independent Audits.
  2. Coding and Documentation Audits can identify problems. An audit will objectively analyze and detect holes in the coding process or uncover deficiencies.
  3. Coding and Documentation Audits focus on the documentation and code training providers need to improve their coding habits.

Benefits of an Audit

  • Proper documentation in your medical records means less fear of third-party audits, recoupments, and other penalties.
  • Aid in preparing claims accurately the first time, and prevent delays and denials.
  • Avoid triggering a compliance audit for inappropriate coding. Incorrect coding can affect your Medicare payments and trigger audit liability.
  • Confidence that your medical records are clear, accurate, and up-to-date, and will support the claim you submitted to the third-party payor.

Physician Education

When requested, our staff will meet one-on-one with the physicians or in a group setting to deliver practical documentation training. The overall goal of our training program is to combine sound documentation principles and implement the use of well-documented comprehensive coding policies to:

  • Provide consistency, accuracy, and reliability of the coded data in a provider’s database, ensuring greater compliance with government regulations.
  • Assure sound and ethical coding practices resulting in enhanced reimbursement.
  • Provide back up if the government questions coding practices, or other third-party payers, ensuring confidence with your coding policies.

These independent audits help you find ways to enhance clinical efficiency and can help protect the financial position of your medical practice.

An independent Coding and Documentation Audits can:

  • Protect against fraud. Coding must match the services for the claims paid by the insurance company.
  • Find variances due to incorrect coding or incomplete documentation
  • Identify and correct the coding and documentation problems before challenged by insurance or government payers.
  • Ultimately find new opportunities for reimbursement.
  • Correct the providers’ use of outdated or incorrect codes.

Contact us to start a discussion.

Read more: Brochure ebix Code Documentation Audit