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Growing Importance of Coding, Document Audit & Compliance

Auditing has been a vital and integral aspect of governance and quality management for organizations across industries for decades. When it comes to healthcare, new guidelines implementation of the latest ICD-10, CPT and HCPCS Level II codes, with a database of over 71,000 extensive procedural codes, has pushed many healthcare organizations to consider alternate approaches to assist the providers with their coding and documentation needs.

One approach to making the best use of this complex system of codes is leveraging technologies such as Artificial Intelligence (AI) and Machine Learning (ML). Such technologies would lead to fewer errors in billing and coding, and allow reduced lapses in payment. Through this blog, you will learn why audits for medical coding and compliance with the latest coding technologies are extremely important for clinics.

Why Medical Coding Audits Are Important

Medical coding audits, when done regularly, will support the implementation and enhancement of clinical documentation improvement (CDI). Audits done by special CDI teams will ensure documentation is optimized, allowing KPI metrics for staff evaluation. Audits are important to ensure:

Improved Documentation Quality- Having accurate and reliable input is extremely vital in healthcare. With the right compliance audit program, followed by productive feedback and constant follow-ups, the quality of your data will improve significantly. This, in turn, leads to better research in the future, and gives healthcare organizations more opportunities to receive funds or grants.

Increased Operational Efficiency- Manual medical coding and billing is a huge challenge for coders all around the world. A CAQH index report has indicated that every manual transaction costs approximately $4.40 more than an automated transaction. To avoid revenue leakage on this scale, automated auditing can be very useful. It can even detect potential errors in advance.

Better Patient Experience- By streamlining coding across the practice, the claims go out with all billable codes. When the patients receive their Explanation Of Benefits from their carrier, all codes match the rendered procedures allowing for less confusion.

Improved staff/physician relations- When proper and timely audits are done, management can quickly check and rule out documentation errors induced by all concerned parties, including physicians, at the right time. When the right practices are in place, all stakeholders in patient care will understand how their work processes affect the other more easily. Regular feedback and transparency in operations also ensures better quality of work.

Accurate reimbursements- Claims being underpaid or overpaid due to incorrect medical codes have plagued hospitals, clinics and urgent care centers for a long time. With AI auditing practices, it becomes a lot easier to ensure that both healthcare organizations and patients get the reimbursements due to them on time.

Eliminate billing fraud- Compliance issues arising out of billing fraud have become a major issue in healthcare. This could be due to the lack of proper documentation, a perceived lack of medical necessity or incorrect coding. Regular medical coding audits can uncover all improper billing practices. Automation of the process can go a long way in eliminating incorrect billing or fraud.

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Frequency of Coding Audits

How frequently healthcare organizations should audit medical coding can depend on a number of factors. These can include the size of the organization, the staff turnover and other regulatory updates. Experts recommend an external coding audit at least once every year. However, many healthcare facilities conduct monthly external coding audits to reap more benefits from the process.

Benefits of Coding Audits

Some key benefits of external coding audits are:

  • Higher consistency
  • Development of Coders
  • Better Compliance
  • Clinical documentation improvement

Monthly coding audits can help healthcare organizations detect errors with greater frequency and accuracy. Automated coding audits, using AI will prevent revenue leakage by rectifying errors on a daily basis. The insights gained from these audits make it easier for healthcare organizations to easily identify areas for clinical documentation improvement, and this enhances the entire coding process and improves business revenue.

Reaching New Heights with AI and NLP

This blog has clearly established how adopting rigorous auditing practices can enhance employee performance and increase organizational transparency in healthcare organizations, clinics and urgent care centers. With AI-based auditing tools rising in popularity, the onus is on organizations to choose the right technology partner to ensure complete compliance. Exdion Health, the latest AI-driven platform developed by Exdion Solutions, has pioneered new ways to optimize compliant coding practices and increase revenue. The platform interfaces with an organization’s EMR systems either through bots, or by using various application programming interfaces (APIs). exdionhealth analyzes 100 recent patient encounters to determine how each medical practice approaches coding. They are then informed about what changes they need to make to improve their overall performance and stay audit-risk free at all times. All recommendations are compliant with state and federal guidelines. Get in touch with us to automate your coding process with cutting-edge AI & ML technologies.

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