Medical coding audit helps healthcare providers enhance and implement correct clinical documentation processes. Effective audits have ensured the recovery of millions in improper payments in Medicare and other insurance schemes. In today's competitive healthcare landscape healthcare organizations must have regular auditing practices in place to promote organizational transparency and employee performance. However, to witness the right outcomes, organizations need to partner with an experienced medical coding audit partner.
Outsource2india has over 22 years of experience in providing in handling the most complex coding file audits with absolute expertise and integrity. We specialize in end-to-end medical audits; from outpatient and inpatient procedures to behavioral and dental health treatments. We designate a qualified team to audit your files, create controls to catch and prevent mistakes and set up correct benchmarks for improvement. Our clients bank heavily on our understanding of codes and experience to make their healthcare processes compliant with regulations and save on expenses and time.
As an established medical coding audit services providing company, we provide a range of coding services to our clients. The most important services among them include -
We audit CPT codes to determine if it has been improperly used. Issues arise at the time of unbundling, upcoding, improper reporting of time-based codes, using unlisted codes without documenting, failing to check National Correct Coding Initiative (NCCI) edits when reporting multiple codes. We look into each of these aspects during the review.
Many codes are to be used on claims to specify where services were rendered. Each payer has their place of service code. We audit codes to ensure there are no mistakes in the place of service. This ensures you do not get paid less for your services.
Improper use of modifiers can result in denial of claims. We audit files for missing or misplaced modifiers. Our modifier audits are carried out to tell payers that there were special circumstances regarding the provision of care. Our assessment of the correct use of modifiers is based on rules as well judgment.
When submitting claims for payment, the diagnosis codes reported with the service tells the payer as to why service was performed. The right codes help support the medical necessity of the procedure. We audit files to ensure the assigned codes correspond with the medical necessity. Likewise, we audit to ensure the diagnosis code for a patient is not changed to match the diagnosis codes listed in the coverage policy.
We audit operative reports ensuring there are no errors in the coding for post-operative diagnosis. We also make sure that coding for further defined diagnoses or extra diagnoses found in the operative report is complete and correct. Our task entails checking if the codes are the latest and are correct.
We audit files to check if all the documentation leading to the procedure are correct. We check the files for the checkup reasons and related history, physical examination findings, and diagnostic test results, place of service, date and identity of the provider, clinical impression or diagnosis, plan for care etc. Our audit ensures there are no shortcomings in the documentation to cover the procedure.
Bundling codes need to be audited and understood well to ensure providers do not get paid less. We audit the single code that is used to replace the other codes to ensure the payment made under the single code covers all the basic costs of the procedure. We review files to ensure compliance with Local Medical Review Policy and National Correct Coding Initiative.
Our coding audit services also includes providing audit recommendation for correcting problems. Our audits take into account the cause of issues. Our recommendation involves documenting in details about the ways to fix the existing flaws and address the actual cause to eliminate recurrence of coding mistakes or failure to comply with laws and regulations.
When an organization chooses us to conduct a medical coding audit, it may have many reasons for doing so, ranging from efficiency to liability issues. Here are some of the top reasons organizations engage medical coding audit company -
During the process of coding, a lot of unwitting mistakes happen and in most of the times, they get interpreted as false representations. Such mistaken impressions can cause providers to get entangled in legal issues. Medical coding helps to eliminate such a possibility.
Sometimes provider coding varies greatly from national averages. This can be a sign of an inherent and deep-rooted flaw in the system and can lead to huge revenue loss. The medical coding audit helps to measure the consistency of coded medical data. Timely detection of variation helps in improving coding quality and complying with federal guidelines.
Regular medical coding audits help to find problem areas early on in the process. Based on the audit findings providers can take appropriate corrective action. This way healthcare providers can stay safe from violating government rules and payer rules and inviting legal and penal actions.
Sometimes outdated knowledge of coding can lead to undercoding, code overuse or poor unbundling habits. All this results in claims delay or denials or worse. Medical coding audits can help avoid these situations by nipping issues in the bud and help the provider stay compliant at all times.
A common issue with most healthcare providers is lost reimbursement opportunities due to reduced payments. Coding audits help uncover all reimbursement deficiencies and ensure there is no such repetition in future.
Our coding audit process consists of the following steps -
We sit with you to understand your coding process and identify the areas that need to be audited. In other words, we identify inconsistent clinical practices and devise ways to close the gap. We look at all the available data to devise a robust strategy
After we look into your overall process we determine the correct measurement criteria for the review. Thereafter we find the factors that will decide whether or not the criteria are fulfilled. We usually bank on proven methods to determine the right standards for measurement
To identify the right records to audit, we first categorize the patient population group to be evaluated. We categorize the population based on gender, age, clinical status, and treatment regimen. This helps us know exactly which patient to exclude or include
If enough records are not audited, the statistical significance of the audit gets influenced by sample size. Based on the categorization of the population, we choose around 10 per cent of the eligible charts for review
In this step, the details of the audit such as the individuals involved; the date and time for it to be performed; the exact number of charts to be audited; etc. are finalized. We procure charts as per HIPAA compliance. This is followed by a detailed audit and collection of data
After data collection, we summarize the data to meet the focus of the audit. The summarized findings are reviewed through several stages to eliminate errors if any and ensure it effective enough to meet the focus of the audit
The completed audit report is passed on to the client. We also assist the client to identify the opportunities for improvement and establish the correct benchmarks to help them bring about an improvement in their process
As a reputed medical coding audit service provider, our audit services offer the following benefits to our clients -
Appeals to medical denials are always a costly and time-consuming process. Our audits assist you to monitor your internal processes across a range of metrics and help you can gain a holistic view of the entire revenue cycle thereby reducing the need to spend money and time on countering denials.
We assist our client's lower rate of claim denials and rejections by categorizing and analysing them for issues that lead to errors. This helps put a complete check on improper coding and consequently helps in checking fewer payments and denials.
Being a top medical coding audit company, we make sure the data is highly secure. We are compliant with the ISO 27001:2013 standards and ensure the best protection to your data.
We audit files to ensure issues such as fraud, abuse, upcoding, unbundling etc. that lead to compliance violations are under complete check. We also ensure that issues like lack of documentation or documentation with errors are eliminated to comply with HIPAA rules.
We assist our clients to establish compliance standards by developing a code of conduct consisting of written policies and procedures. The overarching objective is to assist employees to carry out their job responsibilities with perfection.
After the audit, we educate the staff on the flaws and ways to improve coding practices with proper checks and benchmarks in place. Our post-evaluation coding education entails teaching staff on modifier usage, CPT-4/ICD-9-CM coding, Mid-level provider coding etc.
We offer ways to help you scale our solutions on demand. If you deal with bulk medical data coded and ready to be filed, we'll will alleviate the workload.
We believe agility is everything in medial coding audit performance. We work with medical coding audit tools and technology to accelerate the outcome.
We have highly qualified auditors with rich experience in the medical coding framework. Our team includes professionals who have no less than 8 years of experience as an auditor.
You may contact our team of qualified medical coding support agents with whom you can keep in touch to get project updates or stay in touch.
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Hello, I wanted to reach out to you directly and express my gratitude for the hard work that the Data team, as well as the AR team, has done with EJ practice. I have pushed both teams extremely hard over the past month and their efforts, as well as ours, have paid off.RCM Account Manager,
Outsource2india has over 22 years of experience in helping healthcare organizations boost their financial well-being with end-to-end medical coding audit solutions. Over the years we have established ourselves as an authority in medical billing and medical coding audits and are trusted by some of the most renowned healthcare providers and clinics in the US. We audit more than 1 million medical records annually and have a proven track record of 98 per cent accuracy. Having assisted our clients recover a cumulative amount of several million dollars in improper payments, we guarantee a great improvement in your overall coding process.
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