Physician Practice

The coding manager's role during the audit process

Physician Practice Insider, January 24, 2017

Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the Office of Inspector General (OIG) or Recovery Audit Contractor (RAC).

A coding manager’s responsibilities include:

  • Planning the coding audit process
  • Organizing the resources necessary to conduct these audits, which will assess the coding staff’s skills
  • Encourage staff members to learn more about disease processes and clinical interventions to improve their coding performance

An internal coding audit program is the monitoring effort that ties together all coding management functions. Managers must select topics that will allow them to develop an exemplary coding program. They should consider all available topics but select only those that are applicable to their setting and that will improve the team’s performance.

Managers should consider whether any of their coders are new to the profession or team. Managers could monitor their performance to determine whether it is at an appropriate level. Coding quality is gauged in the 95%–96% range.

Managers must determine whether their new coders are meeting this level of proficiency. Conducting an audit of their current work can answer that question and lend insight regarding necessary corrective measures. Remember that corrective measures are not intended to mean punitive actions but rather corrective actions, which may include focused education, additional reference materials, or closer monitoring.

External or internal audits that have identified weaknesses and claim denials attributable to coding may signal other areas to monitor. Capturing denial reasons attributable to coding serves to identify ideal topics for in-services. Managers can use the findings to implement education programs that can help reduce denials. Reducing coding denials is something tangible to demonstrate the value of your team members to upper management.

Managers also may consider auditing confusing conditions such as sepsis and septicemia or documentation-driven services such as infusion, for which the combination of inadequate documentation of start and stop times and improper coding yields incorrect results.

Managers confronted with multiple appropriate issues to monitor should focus on one at a time until each is resolved and team members are performing at the level expected of them. Internal reviews should apply to all team members, including contractors, and all activities that the team members perform. If team members abstract data into the computer system, periodically review abstracted data for accuracy.

Review discharge dispositions if coders validate them. With many options of topics to monitor, managers should consider developing an internal audit calendar to help stay on track. Share this calendar with the team members and the compliance department so everyone is aware of each month’s focus.

This article originally appeared on JustCoding. Read the full, detailed article here.

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