Question

New to your role as a revenue cycle manager, you are nonetheless surprised to learn that there is no formal process in place for isolating potential areas of compliance concern. You recognize that this would generate a focused approach for internal or external auditing, leading to identification of coding compliance concerns and opportunities for coder education. Recommend to the coding supervisor a minimum of four best practices for determining focus areas for auditing and monitoring of coding compliance.

Answer 1

Best practices for determining fous areas for auditing and monitoring of coding compliante.. • Establish your coding compliance goal - Facilities should adopt a standardized method to measurce coding quality performance. A coding audit will seave as a baseline indicator of coding accuracy, first by identifying sout causes for coding errors , which should decrease variance and increase geliability. Second, an audit will identify strengths and weaknesses of coded, thereby facilitate the establishment of education goals. Determine the frequency of reviews How ofton should you facility perforn intornal audits, frequency should be determined by different variables. Nolume of cases may warrant more frequent audits Problematic specialties determined by a random internal audit may warrant a more focused and frequent auditing protocol. The best practice is to perform internal audits on a quarterly basis, with an external audit performed annually to validate internal audit consisteny. Your ASC will want to nip any issues in the bud sooner that lator. Decide on the type of review - Your facility will need to determine whether it will perform a random or a focused audit. A random audit selection is a representative Sample of your facility's case mix. A fowsed audit selection is a sample of accounts from a pse identified pooblem areal speciality. Most facilities that perform internal audits will perform a random audit of its multispeciality proxedures. If the audit reveals a pattern of repeated coding errors, it may elect to perform a focused audit targeting the specific issue to verify the extent of the problem and intiate corrective measures .

Determine the financial classes - While RAC audits and accusate Medicare reimbursements are a primary fows for many Aces, coding eadors do occur amongst the vadying commercial players keep in mind all financial classes, whether Medicare of commercial, when determining your initial baseline audit :