Health Information Management

Know which coding issues to include in your facility's 2011 audit plan

HIM-HIPAA Insider, January 11, 2011

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With an ever-growing list of RAC-targeted MS-DRGs and a host of coding compliance traps that continue to haunt coders, narrowing down topics to audit internally is no easy task. Where does one even begin?

Your previous year’s audit is a likely place to start, says Julie Daube, BS, RHIT, CCS, CCS-P, manager of coding quality review and education at Care Communications, Inc., in Chicago. “If you audit and identify a weakness, this is something you should probably delve more heavily into the next year. The results are what should guide your next audit,” Daube says.
Another place to look is your Program for Evaluating Payment Patterns Electronic Report (PEPPER), she says. Your PEPPER provides hospital-specific data statistics for MS-DRGs and discharges at high risk for payment errors. It can also help you identify potential outliers, overpayments, and underpayments. Finally, your RAC’s website can also be helpful with respect to guiding a coding audit because it lists targeted issues for your region, says Daube.
Most importantly, hospitals must think proactively rather than retroactively, says Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM, NCAL Revenue Cycle, at Kaiser Foundation Health Plan, Inc. & Hospitals in Oakland, CA. “We need to take a step back. Although RACs are in full force, we’re still reacting to them. Hospitals need to be proactive on an ongoing basis,” Bryant says.
Note: To read more, visit the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have access to this article in the January issue of their newsletters.

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