Top 6 Questions to Ask When Choosing a Medical Coding Audit Vendor

By Angela Knight, CHCAF, CHTSIM, RHIT, Director, Audit | Posted: 10/23/2020

nThrive medical coding solutions & education

A trusted health care revenue cycle management vendor can be an invaluable partner when helping your hospital or medical organization develop and maintain a complete medical coding quality compliance program. Ensuring medical coding quality is crucial when optimizing your organization’s denial management practices and helps reduce missing revenue while avoiding financial and compliance risk from things like OIG audits.

Even if you have a well-run internal compliance program, an external medical coding audit can help validate quality and identify any opportunities being missed that could further enhance your revenue cycle success.

When choosing a partner to perform medical coding audits for your hospital or health care organization, ask the following questions:

  1. What available references do you have?

    Talk to other health care systems or medical organizations about their experience with various vendors and find out which ones they recommend and which ones they don’t. When your reimbursement and the bottom line of your financial performance is at stake, you don’t want any uncertainty regarding vendor performance.

  2. What range of services do you provide?

    Choose a partner with the ability to perform a wide variety of medical coding audit types, not just one specific type such as MS-DRG validation only. Versatility allows flexibility and ensures your specific scope and needs will be met.

  3. What reporting capabilities do you have?

    Look for a vendor capable of providing statistical findings to help identify patterns and trends in coding and documentation. This will allow you to identify and target specific areas of improvement. Choosing a partner with the ability to provide the targeted education your team needs to grow and succeed will help expedite remediation and improvement.

  4. How involved will our medical coders be in the audit process?

    Ensure the vendor’s coding audit process includes strong coder involvement, allowing for coder comments and chart-specific discussions. The more involvement and trust coders have in the audit, the more successful the process and overall outcomes will be.

  5. How experienced are your auditors?

    Make sure you know the experience level of the vendor’s auditors. What are their credentials? How much education and training do they have and are required to complete on an ongoing basis? What is their tenure with the organization?

  6. Do you have an internal quality assurance (QA) program?

    Ensure the vendor has an internal quality check and internal QA program for its auditors. nThrive recommends a standard of 20 reports peer reviewed per auditor per year.

Overall, the best medical coding quality compliance plan should provide:

  • Frequent reviews
  • Continuous and timely support and feedback to the coding staff
  • A variety of chart selection methods
  • A process that supports ongoing coder education
  • Consistent, complete, and compliant reporting of coded data

A trusted vendor partner can go a long way in assisting your hospital or health care organization in developing the best medical coding audit compliance plans based on your specific needs.

Are you ready to schedule your annual coding audit? Click here to contact an nThrive expert today.

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