Medical coding is a process burdened by compliance risks, legal hassles, and lost revenue when not done right. That’s why medical billing and coding companies need to conduct periodic coding audits to ensure the process functions the way it is meant to. As a service provider, ensure your coding team and their operations undergo regular audits to improve accuracy and efficiency.
A coding audit is a review of the coding processes of the medical office or practice, usually done by reviewing patient medical records and corresponding codes generated.
This can be done both internally and externally. Experts advise medical billing and coding companies to get a combination of internal and external audits in a year to ensure no issues go unnoticed.
A coding auditor’s work includes but is not limited to, the following.
As a medical service provider, you could have an in-house coding team or work with third-party medical billing and coding companies. Both ways, you should be ensuring coding audits occur regularly to reap the below benefits.
Sometimes, manual coding errors or errors while calibrating coding tools may lead to low coding accuracies. As a result, one particular type of service could always be coded wrong, or a specific modifier may be added to codes, leading to denials and rejections. An expert auditor can identify these inaccuracies.
New coding guidelines are released regularly; what worked a year back may cause errors and denials now. Anytime a significant change in compliance or regulations happens, it would be beneficial to conduct an audit to find compliance gaps and fix them.
There could be errors in any part of the RCM operations, including coding. Coding audits, when conducted regularly, help identify these errors before they shoot up the denials and rejections rate. Increased denials and rejections will lead to revenue dips and financial instabilities.
Sometimes, your coders may need additional training to cope with newer compliance changes or upskill themselves. Coding audits are a great way to identify such needs and intervene at the right time.
Coding inefficiencies could be one reason your practice may not be minting revenue like other competitors. Coding audits will help compare your coding efficiencies with industry standards, and you can strategize and make changes to match.
There are certain problematic trends in coding that could be consistently causing errors in certain types of bills. A coding audit can help unravel these trends.
Quintessence and medical coding audits
Quintessence’s internal QA team performs different kinds of audits based on deep analytics. After each audit process, our teams discuss intervention strategies and implement them, upgrading our coding processes regularly.
Quintessence’s coding processes are also regularly certified by external auditors, and these auditing processes happen multiple times a year. Our coding processes, backed by ML-based coding tools, expert coders, and supportive auditing, enhance the precision of coding and ensure the right services are captured and sent for reimbursement.
Unless medical billing and coding companies understand the importance of coding audits, they would only do it for the sake of compliance requirements. As a healthcare provider, your revenues would be affected when the coding team keeps churning out low-quality, imprecise codes daily. Talk to Quintessence experts to learn about our internal and external coding audit processes.
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