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Defend code assignments to help improve coding quality and reduce take-backs

HIM-HIPAA Insider, August 17, 2015

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While some HIM professionals may feel a sense of relief knowing RAC audits are on hold for the remainder of 2015, that should not deter workforce members from keeping track of denials and appeals and defending code assignments.

Other auditors are still on track and may be looking for the same errors that RACs once pinpointed, says Cathie Wilde, RHIA, CCS, an AHIMA-approved ICD-10-CM/PCS trainer and the director of coding services for MRA Health Information Services in Quincy, Massachusetts.

Most major health plans are tracking claims and flagging denials, making it all the more important for organizations to ensure their coding and documentation is up to par, agrees Kim Carr, RHIT, CCS, CDIP, CCDS, an AHIMA-approved ICD-10-CM/PCS trainer and ambassador as well as the director of clinical documentation at HRS. "Everybody is jumping on board now with the denials," she says.

In essence, with RAC audits on hold, hospitals may have experienced a decrease in the number of audits that must be addressed. This lull in audit activity means now is a good time to examine query processes and physician documentation to ensure your organization is prepared for any audits that come your way. "Ideally, it's good to look at that process when you have a bit more time and are not in the thick of things," Wilde says.

With ICD-10 coming down the pipeline, auditors may not have a handle on how certain diagnoses and procedures should be coded, which is why hospitals will need to carefully review any future ICD-10 audits rather than assuming auditors are correct. "It's all new to everybody, so [auditors] are getting a feel for it as well," Wilde says.

Continue reading “Defend code assignments to help improve coding quality and reduce take-backs” on the HCPro website. Subscribers to Medical Records Briefing have free access to this article in the August issue.

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