Often when we hear the word audit, we cringe. Is it the fear that we are doing something incorrectly? Or is it the fear of getting blamed or “caught”?
In our recent hospital reimbursement webinar, Jackie King, Director of CAH Education at ArchProCoding, emphasized audits as an important tool for education and uncovering revenue. Performing audits regularly can also:
Jackie recommends hiring a third-party auditor to either start or refresh your audit practices. A third party brings in fresh eyes, and often you can adopt some of the same spreadsheets and tools for your own audit process.
When talking about coding and audits, one thing is at the center – clinical documentation. All touch points with the patient, beginning with patient registration, play a role in the claim process.
Working with your team – front, mid and back office – to ensure thorough clinical documentation provides the following benefits:
Audits also stop revenue leaks! For example, if you see missing start/stop times, missing billable hour charges, or other missed revenue opportunities, you need to speak with your staff.
Coders understand modifiers to be a tool to paint the complete picture of a charge. Applying billing modifiers, based on documentation, is solely the job of the coder – not billing staff. If billing staff does add a modifier it should never be for the sake of “getting paid” (this would be fraud); it should only be done under the direction of a coder.
Accurate coding depends on complete documentation. Documentation may not support a code or modifier every time, but coders should look for educational opportunities to help correct and capture revenue on future charges.
Common clinical documentation pitfalls that may impede coding include:
Make use of your state’s MAC tools for educating providers on documentation improvement.
You are the coder; you are the auditor! Happy Coding!
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