Tip: Questions to ask when auditing physician coding patterns
Compliance Monitor, August 11, 2004
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When evaluating physician coding patterns, there are four things to resolve off the bat, said Terri Gilbert, CPC, CHC, director of physician services at HP3, Inc., in Bethlehem, PA.
1. What is the purpose of your audit?
2. Is coding accurate and timely?
3. Who does the coding? The physician? A credentialed coding professional?
4. Documentation: Are codes correct or is the procedure underdocumented?
Inter-rater reliability, the measure of the agreement among your raters, is crucial, Gilbert said.
"When you have a group of auditors, you want to make sure they're looking at things in the same way," she said. "This is also your [quality assurance] process: How much consistency is there within your audit program?"
Inter-rater validity-how well you're measuring what you set out to measure-is also important. "It's impossible to have 100% consistency across the board-it's subjective," Gilbert said. "Make sure you touch the major areas so you have validity to your audit process."
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