Revenue Cycle Management (RCM) is a critical element in today’s healthcare system and medical coding audits have a very significant impact on it. Medical coding audits should always be one step ahead of recognizing mistakes, rather, it is a necessity for proficient billing management, compliance achievement, and maximizing revenue cycle management. Regular audits comparison to the ever changing coding systems and regulations is the only way to stay economically viable within the practice. This article focuses on the medical coding audit, its importance, the effectiveness of RCM and best audit practices that can be employed by healthcare organizations.
The Necessity of Medical Coding Audits
Coding audits provide an additional line of defense to the healthcare provider by helping point out potential errors in the coding, billing, and compliance which could get the provider in trouble such as claims that are going to be rejected or penalties imposed on the provider. Audits on a regular basis also minimize the risk of abuse and ensure that providers are paid accurately for their services. Effective coding audits cover a comprehensive range of services that include checks on the accuracy of the coding, claims verifications, compliance checks, and revenue cycle management. If done accurately, audits assist in improving the accuracy of claims, speedier reimbursement, and lower operational costs.
How Medical Coding Audits Improve Revenue Cycle Performance
- Catches Coding Mistakes Leading to Denials
The primary concern of audits of coding is to locate coding errors that might potentially cause denials. There are some basic errors in medical coding like wrong coding or missing the most current codings which results in the claim being rejected from the insurance firm or Medicare/Medicaid. Audits are done periodically so that healthcare institutions do not submit erroneous data and incur unwarranted delays that do not allow claims to be presented on a timely basis. Increased acceptance rates and reduced reimbursement times are made possible by eliminating auditing errors; it is a critical aspect of sustaining positive business cash flow.
- Enhancing Adherence to Compliance Issues
To protect against hefty fines, compliance with healthcare regulations like HIPAA and CMS (Center of Medicare and Medicaid Services) as well as payment rules are important. Medical coding auditors check if there are standards which need to be checked and adhered to like these regulations and the correct services that are billed. Auditing ensures that the codes utilized in billing are appropriate for the services received to enhance compliance with regulations and the prevention of fraudulent billing or wrong reimbursements. Routine audits allow healthcare providers to familiarize themselves with new laws and policies as well as the recent best practices in healthcare.
- Optimizing Revenue Cycle Management
The process of a medical coding audit significantly aids revenue cycle management by improving billing processes. When problems are discovered consequently and correct them at that point during the claim process, the chances of the claim being denied are greatly decreased. This ultimately results in the claims having fewer obstacles to overcome and thus paying out quicker which improves financial performance. At the same time, audits also assist in locating specific billing practices that require analysis to increase efficiency, lower administrative costs, and reduce wastage. Improved audit design leads to better RCM processes, which improves smoothness and predictability of cash inflow.
- Enhancing Financial Transparency
Audits also enhance the financial transparency of healthcare organizations. Through evaluating the practices of billing and coding, audits help detect discrepancies between the amounts that were paid and supposed to be paid. Such transparency is essential for proper financial statements, and practices to be able to run their finances without problems. With precise and prompt reports generated from the audits, practices can make better informed decisions regarding the allocation of resources and the optimization of revenue cycle operations. It allows, furthermore, for better estimates concerning reimbursement, which in financial terms, leads to less ambiguity.
Best Practices for Medical Coding Audit
- Implement an Audit Cycle
To get the most out of medical coding audits, health institutions should construct an audit cycle. Periodic audits, be it quarterly, bi-annual, or annual, help in early antifraud detection and discrepancies management. Regular audits enable organizations to solve coding and compliance concerns in a proactive manner. Because audits are part of business as usual activities, they are less likely to be forgotten or postponed when a schedule is in place.
- Concentrate on High Risk Areas
Lack of adequate procedures to plan the audits may lead to failure in planning adequate coverage of the entire coding process. However, it is relevant to note that some areas have a higher probability of risking coding errors than others. These areas include:
High volume codes
These are certain types of codes which are prone to overuse and misuse.
Complex procedures
These are more advanced treatments and procedures that tend to be more error prone.
Specific guidelines for each payer
Insurance companies or payers have unique rules and guidelines that differ from one another which is a task to keep up with.
Changing rules and regulations
Healthcare coding practices such as CPT, ICD-10, and HCPCS coding systems are changing more frequently these days. Auditors should check if the coding is up to date with the new changes. Avoiding problems that may affect the revenue cycle requires attention to potential issues in complex areas to achieve better audits.
- Include a Skilled Coding Team
The output of the medical coding audits is very reliable when supported by a skilled and proficient coding team. Medical organizations should hire or work with a qualified medical coder who is knowledgeable about the different coding systems such as CPT, ICD-10, and HCPCS codes. These people know how the coding and laws are applied and actually carry out the audit. Employing experienced and good coders increases the chances of detecting mistakes in time and achieving compliance with regulations.
- Use Technology to Improve Audit Performance
The effectiveness of coding audits is enhanced by advanced audit software to improve speed. The technology is able to eliminate a lot of guesswork. Coders are able to fix and flag mistakes and draft reports in a fraction of the time it normally takes. Let us take for instance the possible usages of automated auditing software which can check billing codes with regulations and determine discrepancies and errors which can be worked on. Such tools also generate documents that could be useful during audits or disputes with payers.
- Ensure Consistent Training and Learning
After all the audits have been done, it does not end there. Continuous training and education are imperative in as far as having quality coding practices is concerned. Coders need to attend workshops, webinars, and conferences conducted regularly to master the latest changes in coding practices and regulations. This way, healthcare practices can ensure that their coding teams are continuously learning so that they can code and bill accurately.
Medical coding audits are an essential tool any provider will need to master to optimize revenue cycle management. Medical coding audits assist healthcare providers in spotting errors, regulatory compliance, and improvement of claims, which ultimately enhances revenue. Organizations benefit from best practices with coding audits as these ensures a seamless billing process. Such practices include scheduling regular audits, targeting main risk areas, usage of technology and having expert coders.Regular audits of coding should alleviate, claim denial, and return times therefore, financial health of healthcare practices would be improved.
Want to improve the revenue cycle operations of your healthcare practice? Get in touch with TechCare Global for professional coding services and get help in aligning with the most current medical coding standards.
