The Value of a Complete Medical Coding Quality Audit Program

By Angela Knight, CHCAF, CHTSIM, RHIT, Director, Audit | Posted: 10/21/2020

Medical coding quality audit staff at nThrive

One of the top defenses against risk, exposure and low reimbursements is a strong medical coding quality audit program. With this program, hospitals and health care organizations can achieve coding and financial success, quality outcomes, and avoid costly penalties. The program identifies areas of opportunity for risk and/or areas of concern while also identifying areas that are functioning properly. Areas of risk are monitored more frequently and in turn, this improves the desired outcomes that can strengthen the overall success of your organization’s revenue cycle and bottom line.

Building a Medical Coding Audit Program

The integration of a coding audit program within a health care organization allows access to the objective of the audit outcome and accurately captures the audit details. The audience and overall deliverable are also identified to productively conduct the audit.

The goal is to ensure timely and accurate medical coding by preventing delayed reimbursement with efficient coding turnaround. These coding best practices and efficiency boosts help prevent backlogs while improving denial management and missed revenue. With nThrive’s proven medical coding audit program, your health system can be confident that codes will accurately reflect treatment, diagnosis, and severity while avoiding penalties and recoupments stemming from previous instances of upcoding/improper coding.

Questions to Ask Prior to Beginning the Medical Coding Audit

  • What is the scope of the audit?
  • Who are the stakeholders?
  • What is the data to be used for?

Choosing a Sample Audit

  • Random – Look for areas of improvement.
  • Targeted – Take a deeper dive into areas of suspected or known risk.
  • Audit size – Small insufficient data and large skews data bog down the process.

Share the Health Care Data!

  • Validate those coders audited of a job well done!
  • Educate within areas of deficiency, if needed.

Coding applied by electronic health record (EHR) systems are not always accurate. It is imperative the EHR systems are updated annually with the ICD-10 new code sets.

nThrive’s Coding Audit Services assess medical coding practices across multiple dimensions for accuracy and completeness. Hospitals and health care organizations can avoid delayed reimbursement by eliminating backlogs, expediting turnaround times, and preventing rework. Compliance risk and missed reimbursement are reduced by ensuring coding accuracy through consistent quality assurance and physician coding oversight. Lastly, recruiting and retention challenges are eliminated by sourcing high-skilled coders from a global talent pool while providing ongoing education.

Learn more! Click here to download a copy of ‘Improve coding and documentation deficiencies with nThrive’s on-going coding quality assurance program’. 

Have a question for an experienced medical coding specialist? Click here to ask questions or schedule a coding audit today!