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Avoid hospital audit staffing problems

HIM Connection, May 20, 2003

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Dear Colleagues:

When you're conducting a coding compliance audit, staffing problems can arise from two sources: conflict of interest and competency. First, if you're planning an internal audit using current coding staff, you must have an audit staff that had no part in the coding for the time period you're auditing. Often, HIM auditors are promoted from within and have worked in the HIM department as coders, coding supervisors, or managers. If this is the case, the hospital has two choices. It can avoid internal audits until the time period in question has passed. Or, it can prohibit individuals from participating in audits of material that he or she coded. If it chooses the latter, it is probably best to farm out the audits until the time has passed to ensure the credibility of the audit results.

Second, the hospital must consider the qualifications of internal auditors. It is always wise for the hospital to check the auditors' credentials-especially if this is a first-time audit for either the hospital or the auditor. Testing the competency of auditors is also a good idea. The following steps help ensure competency.

1. The auditor should have valid coding credentials.

Acceptable credentials for inpatient auditing are registered health information administrator (RHIA), registered health information technician (RHIT), and certified coding specialist (CCS). Because CCS is the credential specifically focused on coding, this is the preferred credential for auditing. Because the RHIT and RHIA credentials are academic as well as professional, they may have a positive impact on coding ability.

A recent study indicates that coders with a strong knowledge base in anatomy and physiology, disease process, and medical terminology are more likely to have a high self-assessed coding accuracy rate than other coders. These subject areas are a mandatory part of all healthm information academic programs. In addition to these credentials, outpatient auditors may possess the certified professional coder (CPC), or certified professional coder-hospital (CPC-H) credentials awarded by the American Academy of Professional Coders.

2. The auditor should pass a coding test with at least a 95% proficiency.

Every facility should have a coding test for inpatient and outpatient coding that all auditors must take and pass before they are allowed to conduct a coding audit. The auditors should be retested at least annually. The test should cover both coding and auditing skills. If the hospital does not have its own coding test, several consulting firms have developed tests it can purchase.

3. The auditor should audit a small sample of records with at least a 95% proficiency rate.

In addition to a basic coding and auditing test, all auditors should be required to take a test of practical application of auditing skills. Ideally, a hospital will have a test set of approximately 10 records that have already been audited with correct responses. Then, the auditor's results should be compared with the test answers to determine proficiency.

This week's HIM Connection was excerpted from the book, Coding Compliance: A Practical Guide to the Audit Process. With this book, you'll be able to keep the auditing of your medical records and coding compliance in-house to avoid costly consulting fees. Accurate medical records documentation and coding is at the heart of compliance with Medicare--the key area that the government is targeting for fraud and abuse investigations. Click here for more information or to order your copy.

Sincerely,

Laura Motta
Editorial Assistant

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