Medical Practice Management
Jul 16

The Value of a Coding Audit

Coding accuracy audits can help your organization optimize revenue, reduce compliance exposure, and increase organizational efficiency by:

•   Preventing you from undervaluing services performed (= more money)
•   Reducing/Eliminating rejected claims and reducing back end follow up
•   Keeping you from paying fines and/or possibly going to jail
•   Protecting your practice from being involved in an expensive third party audit
•   Minimizing likelihood that your submitted claims will be recouped by the OIG
•   Diminishing the odds that you will be the target of a RAC audit
•   Ensuring your staff is up to date with continually changing coding rules and regulations
•   Improving the accuracy of your medical records
•   Measuring the performance of your staff to target areas for improvement

Coding errors and misconceptions can result in lost charges and undervalued services. An important result of an independent coding review is the identification of opportunities to optimize reimbursement. Without outside “peer reviews,” errors and gaps in the coder’s knowledge become institutionalized and can be extremely costly in terms of lost charges and reimbursement over time. No payer will ever send payment for more than was billed because they identified an omitted code. Our audit reports address this by identifying missed charges and undervalued services.

The OIG and CMS recommend that all providers have their coding reviewed on a regular basis by an outside independent party with appropriate expertise in that clinical specialty. Only an independent review can serve to identify errors and misconceptions regarding coding, as well as ensure that coding regulatory updates such as new and modified codes, coding edits, and bundling rules are being incorporated into the provider’s coding protocols. In the event of an OIG audit, independent, outside coding audits demonstrate that reasonable steps have been taken to ensure compliance. Additionally, coding audit reports identify areas of weakness that both coders and doctors display.  Organizations can utilize these metrics to improve provider documentation and target areas in which their coders are deficient.

Government and payer compliance and oversight is increasing; now is the time to have a coding audit if you haven't had one performed lately.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →