Reveal the gaps in a coder’s knowledge, showing where further education can spell better performance
Improve the accuracy of patient risk stratification, which is fundamental to quality rankings, public report cards and improved performance under value-based care models
Increase the validity of quality outcomes data
Verify that thorough coding and documentation processes are followed, especially for patient conditions governed by coding and reporting guidelines
A: The optimal compliance program should consist of a mix of audit types:
A: The auditing process should involve multidisciplinary teams, such as the compliance and auditing staff, coding professionals, CDI professionals, physician advisors and representatives from quality and safety teams.
A: While technology is imperative in the world of health care, not all systems are created equal. In many cases, compliance and audit teams must use multiple platforms and processes to leverage their disparate systems. The more unified the systems, the less human error and re-work is required. In short, a single technology platform for coding and auditing (PDF, 431 KB) can improve transparency and effectiveness.
A: A more important metric to measure is reimbursement accuracy, which should be 95 percent or better. Coding accuracy should be similar.
A: Yes. If best practices are only shared internally, an error may become consistent across all coders. An external audit provides fresh eyes to find the blind spots. External audits are vital and should be conducted at least once per year.
A: Attributes you should look for in an external auditing firm are:
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