Medical Coding Audit Services
Medical Coding Audit Services
A Coding Audit is an internal or external review of a medical office’s coding practices conducted by reviewing patient medical records. Medical record audits target and evaluates procedural and diagnosis code selection as determined by physician documentation for completeness and accuracy.
Scope of Coding Audits
➢ A coding auditor looks at several factors in medical office claims, including
➢ Assess the proper use of CPT codes.
➢ Determine the correct places of service.
➢ Look for missing and/or incorrect use of modifiers.
➢ Detect incorrect diagnoses (i.e., does not indicate medical necessity).
➢ Identifying coding and documentation accuracy, trends, and deficiencies (if any).
➢ Verify if supporting documentation is adequate to describe the care provided to the patient.
➢ Identify any bundling or cluster issues (CCI edits and LMRP).
➢ Determine if services are reasonable and necessary.
- Regular coding audits provide many benefits that improve the way your practice operates.
- Ensure that your coding practices follow acceptable, up-to-date standards
- Compare your coding practice to those of your peers
- Identify areas of lost revenue (i.e., under-coding to avoid possible denials)
- Identify areas of compliance concerns
External Benefits of Coding Audits
- Maintain compliance.
- Reduce rejections and denials.
- Reduce rejections and denials.
External Benefits of Coding Audits
- Code to the right level
- Create opportunities to educate your staff.
- Maximize reimbursement
Coding Audit Process
- Recognize that an auditor is a partner
- Recognize that an auditor is a partner
- Recognize that an auditor is a partner
- Look for irregularities
- Unrelated codes
- Outliers
- Make a continuous improvement plan based on results
Types of Coding Audit
- Post-bill
- Pre-bill
- Internal vs External
