Outsourcing Coding Audit – Key Points to Consider

by | Published on Nov 19, 2012 | Medical Record Review

How important is a coding audit? Coding audit helps to review your coding accuracy and from that viewpoint, it is a very significant process. It helps you avoid coding errors that consume your time, resources and money. You also need to keep track of your medical coding activities to avoid coding practices that are non-compliant. Conducting an internal audit may prove rather overwhelming amidst a hectic practice schedule. Outsourcing coding audit is the practical option, especially if you face a shortage of trained and experienced coders.

When outsourcing, you need to consider a few important points to enjoy the full benefits of having an external agency do this important work for you.

  • Ensure that the external auditing/medical review company has substantial experience in actual coding auditing for your specialty. The professionals should be well-versed in the intricacies of medical coding. You can inquire about the qualifications of the company’s auditors.
  • It is important to understand clearly the billing company’s processes or way of conducting the audit. Find out whether they would carry out a random audit initially, and then move on to a more focused audit based on the findings. Also, see whether they will cover Medicare as well as commercial payers.
  • Medical record review companies providing coding audits will need specific chart documentation for the review. Ask your provider what they require – history & physical, operative, pathology, code selection (CPT, ICD-9, HCPCS, modifiers) coding sheet or claim form, and/or insurance payer information. It is important also to verify whether they require electronic access or would accept paper submissions.
  • Rate the usefulness of the review. Ideally, the report should provide the percentage of accuracy vs. variances, in the form of a summary report as well as the preferred form of code over code reporting. Reliable service providers would provide a spreadsheet that shows a breakdown of the coding, including a review of the CPT, HCPCS, ICD-9-CM codes and modifiers. You will also be notified of deficiencies in documentation, and whether your documentation supports medical necessity of provided services. The summary report of the spreadsheet would contain audit scores, documentation improvements, recommendations for education, claims corrections/refunds/rebills and suggestions for problem resolution.

Coding audit conducted by a reliable medical record review company will help you identify issues such as routine under-coding that result in considerable loss of revenue for your practice. It will help enhance efficiency and revenue inflow, and ensure compliance.

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