June 5, 2019

Why Every Practice Needs an Annual Coding Audit

Does your medical practice have an annual coding audit? While a coding audit might sound like a scary thing designed to punish you, that’s far from the truth. In reality, an annual coding audit is an awesome way to assess how your practice is doing in terms of coding accuracy, identifying potential problems before an insurance company does and ensuring you’re not missing out on revenues by capturing all the services that were rendered. Set your medical practice up for success with an annual coding audit from Medical Business Partners!

Audits Are Part of Working in Healthcare

Practices are audited constantly by the government and commercial insurances. While the phrase often comes hand in hand with fear and panic, it doesn’t need to. By proactively auditing your medical coding, you can be prepared in the event that insurance company begins a routine audit or a more serious audit. Remember that receiving a request for an audit does not mean that you did anything wrong. Instead, it’s a way for insurance companies to make sure that you’re getting it right.

Annual Coding Audits

An annual coding audit works by having a certified coder examine your notes and codes billed to make sure you chose the best codes for all the services you discussed in your documentation. It’s best for the audit to be conducted from a random sampling, including new and established visits, procedures/surgeries (if applicable) and very complex visits with multiple or atypical CPT codes. After the coder reviews all the codes and notes, be sure to have a detailed feedback session to learn of any possible issues, guidelines and recommendations. You may be very surprised by the findings, as you may be under coding (missing out on revenue) or over coding (may need to pay back to insurance). In addition, in the eyes of the payer, both under and over coding are considered fraudulent. The key is to keep educating yourself on the latest coding requirements and have professionals periodically assess your notes and codes to certify you are abiding by all the requirements. Keep in mind, sometimes the updates in the payer policies actually make it easier for you to record a visit or a procedure, or start paying for services they previously deemed medically not necessary or non-covered. Either way, proper coding may assure that you’re collecting the maximum reimbursement owed to you and are not stressing over payer audits recouping their payments.

What Things Are Reviewed?

An annual coding audit typically analyzes:

  • Diagnosis, procedure codes and modifiers
  • POA indicators
  • Documentation for the visit
  • Coding trends
  • Educational training and recommendations

Learning from the Audit

Once you get your assessment results back and have a detailed discussion with your auditors, you should have concrete action steps on how to improve any discrepancies. Any trends in errors will be noted, which allows you the opportunity to prevent them from happening in the future. When you have your next annual coding audit, you’ll be able to see how far you’ve come.

Annual Coding Audits from Medical Business Partners

Medical Business Partners conducts many coding audits, leads educational trainings and forums, as well as boot camps for staff and physicians. To learn more about our coding and billing services, start-up consulting, credentialing services or other ways we can help you increase your revenues, please contact us through our website or by calling (202) 390-3966.

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About Team
At Medical Business Partners it is our mission to empower physicians to succeed in the ever-changing healthcare environment by improving billing, streamlining operations, and eliminating all inefficiencies.