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TOPIC: Top ten reasons for conducting coding audits

HIM Connection, November 10, 2003

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TOPIC: Top ten reasons for conducting coding audits

Initiating coding audits in a formal way can be intimidating for some organizations. That's why it's important to openly discuss the issues of auditing and educate the organization from the top down. Education of administration, key managers, and the governing board is important to achieve full support for auditing. Once these people are on board with the concept, then you need to make some important choices and use the resources available to help you design or redesign your medical record auditing process.

When considering compliance auditing, most providers focus on the fact that federal government regulations require organizations to perform this function. Instead, try to put auditing in a more positive light. When presenting the concept of medical record and coding audits to the administration, governing board, and others, present it as a process that will improve the organization, rather than as a chore the organization has to do. Needless to say, it is much easier to run an effective auditing program when support comes in a positive manner than when support comes only because the organization has been told, "you must comply."

When presenting your case, emphasize the benefits that most appeal to the organization as a whole or that appeal to the group you are currently trying to win over. For example, physicians will be interested in the fact that audits provide data that can be used for patient-care research purposes.

The following are 10 benefits of medical record and coding audits:

1. Improved operational efficiency

2. Mitigated damages in the event of an investigation

3. Additional protection against certain legal exposures

4. Improved data quality overall

5. More reliable data for reporting and research purposes

6. Improved relations between health information management/billing staff and physicians

7. Correct reimbursement to the organization

8. Better relations among all departments and functions involved in the reimbursement process

9. Enhancement of auditing by current quality assurance/utilization review efforts

10. A new public relations tool

It is important to educate the board about why your organization needs to perform audits, how they will be performed, and what the board's role is in all of this. Board members should be very interested in this process because they may retain significant exposure and liability for noncompliance due to a poorly run audit process.

This week's HIM Connection was adapted from Coding Compliance: A practical guide to the audit process, by Ruthann Russo, JD, MPH, RHIT and Joseph J. Russo, Esq. Click here for more information or to order.

Check out the Editor's Choice section below for solutions to your records completion problems.

Sincerely,

Kate Alvarez
Editorial Assistant
kalvarez@hcpro.com

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