Healthcare Coding Audits Checklist: Prepare for a Successful Audit

Healthcare Coding Audits Checklist: Prepare for a Successful Audit

Regular healthcare coding audits are necessary to run a compliant, successful healthcare organization. Audits identify issues in medical coding compliance, provide educational opportunities, and help drive decisions within the health system. And while the reason for the audit may differ, the overall checklist for conducting a successful audit remains relatively the same.

Your Checklist for Efficient Healthcare Coding Audits

Here are the steps healthcare providers need to take to prepare for a successful audit:

healthcare coding audits
  1. Determine the scope of the audit. To determine the scope, providers should consider the need for the audit. Are they evaluating overall coding accuracy? Or do they need a more focused review? Some audits may only apply to certain care settings. For instance, DRG audits are exclusive to Inpatient settings, while CPT audits apply only to Outpatient and Professional Fee Service settings. Additional focused reviews include addressing external agency reports, like the PEPPER Report or an Office of Inspector General audit. Providers may also need focused audits to identify areas that generate more denied claims. Audits are the path to educating and preventing all types of issues.
  2. Identify what kind of results they need from the audit. Before an audit can begin, providers need to know what information they expect to receive. At YES, we customize our auditing reports to include the specific information and answers for which our clients are searching. Our auditors provide tailored recommendations based on the initial feedback that our clients provided at the beginning of the audit.
  3. Provide a list of the parties being audited, as well as any facility-specific coding requirements that the facility keeps track of (whether for data collection, quality reasons, or other purposes). It’s also a great idea to include information on unique medical treatments, research programs, or advanced trauma care provided at the facility. Not every healthcare organization provides the same level of care.
  4. Prepare the coding data to be audited using the specified format, then upload it to the auditing software. YES provides our auditing clients with a template to prepare their data before uploading it to our auditing software. If data can’t be provided digitally, it’s entered manually into the template, then transferred to the auditing software.
  5. Utilize the audit results to drive decisions, growth, and future success. Our reports provide actionable insights for our clients to make strides toward continuous quality improvement. For our ongoing audit clients, our trending reports illustrate coder accuracy and other data points over time. Trending reports showcase areas where additional education may be necessary, and the results may be used during team evaluations to spur professional development. If clients identify who provided the coding data, such as physicians or coders, we can customize our education recommendations for those parties.

Why consider using an external audit partner vs. an internal team to conduct audits?

A third-party audit partner brings an objective view to the process. The YES Auditing Services Team looks at each chart individually and provides recommendations based on expertise.

An external partner has a large team they can tap for diverse and specialized coding expertise, whereas an internal team may be limited in their knowledge.

Additionally, since facilities have multiple departments seeking funding, the internal auditing department may have limited access to helpful resources, tools, and educational information that an external partner has.

Audits conducted by an external partner can collect data from a larger time period and utilize an automated process for randomly selecting encounters to review.

You can complete this free questionnaire to see if an external coding audit is right for your organization.

What makes YES auditing services so different?

The YES Auditing Services Team has over 20 years of experience coding and auditing in the industry. Each auditor brings a varied set of knowledge in different settings and specialties that make for an overall well-rounded team. The camaraderie between team members encourages everyone to pool their skills and tackle any auditing project.

Furthermore, the YES Education Team helps our coders and auditors stay current with the latest codes and guidelines. And, if a particular case requires more guidance, they quickly provide the education to fill the need.

Interested in learning more? Touch base with a YES consultant today to discuss your auditing needs and develop an action plan.

Additional Auditing Resources

Elizabeth Kelly

Elizabeth Kelly, RHIA – Director Auditing Services
healthcare coding audits

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