Simply mentioning a coding audit sends shivers up a coder’s spine. Coders acknowledge and support the need for audits; however the mere thought of an audit presents a level of anxiety with thoughts of their coding quality being scrutinized, as they continually strive to balance quality and productivity.
Here are the Top 7 Ways to Reduce Coding Audit Anxiety:
- Accept the reality that audits will continue to be a regular occurrence – With continued focus on coding and billing compliance all healthcare settings and providers are subject to routine audits from regulatory organizations, such as Center for Medicare and Medicaid Services, Office of the Inspector General and payors, to name a few. Then of course there are the individual organizations internal reviews related to compliance, data integrity and quality indicators.
- Understand the goals of each audit and/or internal review – Be sure to understand the purpose of each audit or internal review. What is the focus? Is the focus a new or recurring compliance and/or documentation issue, an issue specific to the individual organization or a coding hot topic trend? Keep the focus in perspective, gather all necessary information regarding the audit focus, related coding and documentation rules, internal coding polices and documentation requirements. Keep current with industry coding issues as well as audit trends and request these topics be discussed during internal coding team meetings.
- Think as a coder not an auditor – Don’t overthink the coding process to a point of crippling coding decisions by becoming both coder and auditor for every account coded. Be confident with coding decisions, no second guessing.
- Adhere to Official Coding Guidelines –Be sure all coding decisions are based on official coding guidelines as well as, reimbursement rules and regulations, and supported by source medical record documentation.
- Accept the fact that there will be auditor recommendations – Given subjectivity remains part of the coding process there will always be different opinions and interpretations. Also, acknowledge oversights do occur and something may be missed during the initial coding process and/or a documentation issue may surface. Keep an open mind and accept the fact there will be auditor recommendations.
- Audit Rebuttal Process – Review auditor recommendations with an open mind. When there is a disagreement with the auditor’s recommendation a formal rebuttal process is warranted. The coder should be given the opportunity to present their initial coding justification, including references to support their coding, i.e., coding clinic, official guidelines, documentation support from the medical record, etc.
- Audits present learning opportunities – Remember, an audit presents a learning opportunity for both the coder and auditor. The learning process for both is ongoing. Audit results should be used as an educational opportunity for coding team members, Clinical Documentation Specialists and physicians.
Following these seven steps and recognizing the audit process is an educational opportunity will reduce coding audit anxiety. While also achieving the happy balance between productivity and quality.