Medical Coding and Documentation Audit Services
The OIG also suggests that organizations implement routine monitoring and auditing processes. Audits can depend on many factors such as regulatory updates and staff turnover. Most healthcare facilities perform monthly audits throughout the year. Medical audits can be random or focused on areas such as office visits, consultations, Emergency Department, inpatient visits, and dental just to name a few. Our experienced auditors will evaluate documentation for accuracy and compliance. Findings often help improve claims processing, reduce rejections and/or denials, decrease incorrect coding issues, and improve provider compliance. Audits can help prevent a costly carrier payback by ensuring claims processing is compliant.
Our Auditing Process
We take a structured approach to auditing, ensuring transparency, accuracy, and strategic improvements for your healthcare organization.
Step 1: Initial Consultation & Assessment
Our process begins with a phone consultation to understand your needs, objectives, and any specific concerns related to coding and compliance. Whether you need an annual compliance review, a focused audit on a specific issue, or an external resource for internal compliance efforts, our auditing services are tailored to meet your needs.
Step 2: Comprehensive Chart Review
Certified and experienced auditors will conduct a detailed review of selected medical records to ensure, at a minimum:
- Evaluation and management levels are supported per documentation for medical decision-making or time-based coding.
- CPT/HCPCS/Modifier code accuracy and proper reporting
- ICD-10-CM coding accuracy and specificity to ensure correct diagnosis coding
- Charge capture validation, ensuring all billable services are documented and reported.
- Edit review for unbundling
Step 3: Quality Control & Compliance Verification
Our audit team strives to meet compliance standards by following the Official Guidelines for Coding and Reporting developed by the American Medical Association (AMA), American Hospital Association (AHA), Centers for Disease Control (CDC), National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS) and published by the American Hospitals Association’s Central Office on ICD-10-CM quarterly newsletters, formally known as ‘Coding Clinic,’ as well as CPT Assistant published by the American Medical Association.
Our team works collaboratively to ensure audit findings are consistently applied. We follow a multi-tiered quality control process to verify the accuracy of coding, billing, and documentation compliance.
Step 4: Audit Findings & Recommendations
- Identified coding inaccuracies with information-enriched rationales
- Documentation enhanced opportunities, when identified
- Areas of potential compliance risk along with corrective actions
- Recommended process and documentation quality
If requested, we can provide a financial impact analysis showing how coding variances affected revenue based on audit results.
Step 5: Post-Audit Consultation & Education
Upon completion of the audit, our clients receive:
- An informative discussion reviewing the audit findings and key areas for improvement and how to address them properly
- An educational plan for providers, coders, and/or billing staff to support future coding and billing accuracy while supporting compliance standards
Medical Coding and Documentation Audit Services – FAQs
1. How do coding audits keep providers and hospitals compliant?
2. In what way do coding audits contribute to staff development and training?
3. How can coding audits affect compliance with healthcare regulations?
4. What long-term benefits can providers and/or hospitals expect from coding audits?
5. How do coding audits improve patient care?
Coding audits ensure that patient records are accurately maintained, which enhances the quality of care. Accurate coding leads to better data for patient outcomes, allowing hospitals to analyze treatment effectiveness and improve clinical practices.
Compliance Made Simple
Benefits of MedCycle Solutions Healthcare Coding Services:
Solving Staffing Issues with Our Medical Coding Services
Many of our clients experience short-term staffing issues such as turnover or leaves of absence. In these cases, the practice needs immediate backfill. MedCycle Solutions employs a team of Certified Professional Coders with the experience your team needs to fill the gaps.
Coding Support: A Solution for Small Practices
Small or start-up practices often don’t have the financial resources to hire a full-time certified medical coding team. Our clients use us as their coding team. We become an integral part of their business, becoming familiar with their specialty and the coding intricacies of their specific practice.
Stay Current with Coding Changes and Updates
Streamline Workflows with Efficient Coding Practices
Outsourcing part or all of the practice’s coding functions can be an effective way to streamline workflows as it ensures that your workforce is efficient and effective and minimizes wasted time. Our clients are assigned dedicated coding staff and work efficiently to ensure accurate and timely medical coding is conducted.
Debunking the Cost Myth of This Service
A common myth about outsourced healthcare coding and auditing services is that it is more expensive than employing in-house resources. When benefits, PTO, meeting time, and lost productivity due to turnover are factored in, outsourcing is almost always comparable to employing in-house coders and auditors.
Medical Coding Services – FAQ
1. Why should my practice consider outsourcing healthcare coding?
Outsourcing healthcare coding can address short-term staffing issues, streamline workflows, and provide a solution for small practices that may not have the financial resources to hire a full-time certified medical coder. MedCycle Solutions offers a team of Certified Professional Coders to fill immediate gaps efficiently.
2. How does outsourcing healthcare coding solve staffing issues for practices?
Many practices face short-term staffing issues like turnover or leaves of absence. MedCycle Solutions provides a solution by employing a team of Certified Professional Coders, ensuring immediate coverage and minimizing the delays associated with backfilling or hiring new staff.
3. How does outsourced coding help in streamlining workflows for healthcare practices?
Outsourcing part or all of the coding functions can streamline workflows by ensuring efficiency and effectiveness in the coding process. MedCycle Solutions assigns dedicated coding staff to clients, learning their practice intricacies and working efficiently to ensure accurate and timely medical coding.
4. Why is outsourced coding considered a solution for small practices?
Small or start-up practices may lack the financial resources to hire a full-time certified medical coder. MedCycle Solutions serves as the coding team for such practices, becoming an integral part of their business, familiar with their specialty, and handling coding intricacies efficiently.
5. Is outsourcing healthcare coding more expensive than hiring in-house coders?
Contrary to a common myth, outsourced healthcare coding services are often comparable in cost to employing in-house coders when considering factors like benefits, PTO, meeting time, and lost productivity due to turnover. MedCycle Solutions debunk the cost myth associated with this service.
6. What can practices expect from MedCycle Solutions' comprehensive outsourced coding services?
Practices can expect consistency, accuracy, timeliness, and professionalism when outsourcing part or all of their coding function to MedCycle Solutions. The dedicated coding staff ensures high-quality coding services tailored to the specific needs of each practice.
7. How can my practice get started with MedCycle Solutions' expert outsourced coding services?
Initiating a partnership with MedCycle Solutions is simple. Contact us to discuss your practice’s specific needs and explore how our Certified Professional Coders can efficiently support your coding requirements, providing consistency and accuracy to enhance your practice.