How Coding Accuracy is Best Determined: A Coding SME Shares Her Industry Knowledge

How Coding Accuracy is Best Determined: A Coding Subject Matter Expert (SME) Shares Her Industry Knowledge

Why is accuracy important in the medical coding and billing field? And how is accuracy determined? We asked Amy Davis, Director, Inpatient Coding and CDI Services, to weigh in on these important questions.

Why is Coding Accuracy Important?

“Coding accuracy is important because inaccuracy leads to denials, rebills, alerts from governmental agencies that provide funding, and potential OIG audits,” Davis says. “From there, the provider may face financial repercussions and legal ramifications.”

Furthermore, Davis describes the impact of inaccurate coding on the healthcare facility as “costly.” An inaccurate chart requires more people to review and correct it. When more hands “touch” the account, this costs the provider time and money. And, ultimately, it might mean the organization loses revenue at the end of the day.

How is Coding Accuracy Determined?

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“Inpatient coding accuracy is best determined by several factors,” Davis says. “The coders’ selection of diagnosis codes, procedure codes, and discharge disposition all weigh in to determine the DRG assignment. If any of those factors are wrong or missing, the resulting DRG assignment will be inaccurate.”

Davis explains that when all the factors add up correctly to the chosen DRG assignment the coder selected, the chart is determined to be coded accurately. To confirm our Inpatient coders maintain the YES coding accuracy standard, we conduct quarterly audits of 15 accounts per coder. Our expert auditors thoroughly review each chart to ensure nothing in the documentation was missed that may impact the DRG assignment.

Auditors flag charts that have errors, such as missing or inaccurate codes, according to an article by Elizabeth Kelly, Director, Auditing Services. In addition to reviewing accuracy statistics, auditors look at the coder’s productivity (number of charts coded). However, these numbers are analyzed separately from coding accuracy metrics, which Kelly clarifies in the article.

How to Maintain a High Coding Quality Standard

how to improve medical coding accuracy

An organization can maintain a 95% (or above) coding accuracy standard by providing monthly coding education. Ongoing education helps coders keep up with industry updates and ensures they have the most current guidance for correct coding.

At YES, in addition to frequent education through our convenient LMS, we engage our coding teams with a monthly Coding Roundtable meeting. Our coding teams break up into smaller groups and discuss topics brought up in our Question Queues, common errors they’ve seen, or client-specific coding guidance.

“We’ve found that breaking up our Inpatient coders into three smaller groups encourages them to participate in the roundtable,” says Davis. “It has been instrumental in maintaining our coding quality standards.”

Providing concurrent feedback through a coder mentoring program is another effective way to maintain or improve coding quality. Review our additional tips highlighted in the article, “Achieve 99% Coding Accuracy with Mentoring, Auditing, and Education.”

When you contact YES HIM Consulting, establishing and maintaining a coding quality standard of 95% (or above) is just a few steps away. Our team of qualified coding and auditing experts is ready to develop a custom plan that addresses your team’s needs.

YES HIM Consulting

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