Internal Coding Auditing Programs
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Internal Coding Internal Coding Auditing Programs Auditing Programs Gloria Litton, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer
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Internal Coding Auditing Programs. Gloria Litton, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer. The Need For Coding Audit Programs. The OIG Compliance Program Guidance for Hospitals states that "an ongoing evaluation process is critical to a successful [coding] compliance program - PowerPoint PPT Presentation
Transcript of Internal Coding Auditing Programs
Internal Coding Auditing Internal Coding Auditing ProgramsPrograms
Gloria Litton, RHIA, CCSAHIMA Approved ICD-10-CM/PCS Trainer
The Need For Coding Audit The Need For Coding Audit ProgramsPrograms
The OIG Compliance Program Guidance for Hospitals states that "an ongoing evaluation process is critical to a successful [coding] compliance program
The data provided by coders is invaluable to an organization in order to provide appropriate data collection and safeguard against the increasing level of external scrutiny of the coded data.
The Benefits Of AuditingThe Benefits Of AuditingTo keep performance and
compliance on trackProvide ongoing feedback on coding
staff performance Improve quality of existing coding
staff Identify missed opportunities Decrease delays in dropping recordsDecrease DNFB
Factors Leading To An Factors Leading To An Enhanced Coding Audit Enhanced Coding Audit
Program Program New coding associates◦ Associate turnover/retirement◦ Additional or expanded hospital services◦ Focus on Revenue Cycle and development of
more stringent DNFB goals Increased external re-review activities
◦ DRG validation requests from payers◦ RAC/Other regulatory reviews
Increased organizational quality review programs◦ Core Measures
Increased payer denials and rejectionsPreparing for ICD-10 implementation
Mary Washington Mary Washington Healthcare’s Internal Healthcare’s Internal
Auditing PlanAuditing PlanWhere we started◦One Auditor/Educator
Chart reviews DRG Validation Reviews from internal and
external requestors◦Quarterly External Audits
Each patient type was reviewed once a year
◦Limited Outpatient Reviews Focus was on inpatient reviews Limited time to complete reviews on all
patient types
How We ProgressedHow We ProgressedFocus on coding quality AND productivityHired additional coding compliance
auditorsIncreased coding reviews for each coderDeveloped a coding review schedule to
include all coders and all patient service types◦ Increased focus on outpatient coding
Maintained our quarterly external review schedule◦ Each patient type is reviewed on a quarterly
basis by an outside coding auditing organization
Coding AssociatesCoding Associates◦18 coding associates
10 inpatient coders 4 outpatient coders
Charge entry for IR and Cardiac Cath 4 emergency room coders
Charge entry for ER services and level of care◦4 coding auditors
2 Inpatient Auditors Inpatient reviews/RAC reviews/ DRG Validation
Reviews Inpatient reviews/Internal Quality Reviews
2 Outpatient Auditors Outpatient reviews/Denials and rejections Emergency Room reviews/Auditing software and
system testing
Coder ReviewsCoder Reviews Increased the number of individual coder reviews
◦ Quarterly reviews for each coder◦ Minimum of 30 records per review
Random selection Patient Service Type
◦ Re-reviews for audit scores less than the coding accuracy standard of 95% Additional review of 30 records within one month of the
initial review Incorporated accuracy scores into annual
performance evaluations◦ Coding accuracy scores are 35% of total job
competencies on annual performance evaluations◦ Coding standards set to match the performance
evaluation categories (meeting expectations, exceeding expectations, and needs improvement)
Auditing ToolsAuditing ToolsImplementation of electronic auditing
software◦ Automatically uploads ADT information and
codes from abstracting software◦ Auditor randomly selects 30 charts from
the that monthly◦ Codes from audit results are entered into
the auditing softwareDevelopment of audit result tools
◦ Audit Review Schedule developed◦ Audit Review Packets are created for each
review Audit Summary Spreadsheet Reports from individual records are generated
Second Level Review ProcessSecond Level Review ProcessIncreased internal quality reviews
◦ Core Measures◦ Readmissions
Developed an automated review process◦ Developed an internal coding review email
Records referred from clinical quality review programs are emailed to the email account
Monitored by coding compliance auditor Reviews and responds to requestors
◦ Automated a pre-bill review workflow process Coders cannot finalize records that meet certain
criteria Records can only be finalized by the coding
compliance auditors
ResultsResultsMet the 95% coding accuracy
standard for 2012 and year-to-date for 2013
Every coder was reviewed internally for each quarter in 2012 and once externally by coding auditing vendor
Increased coder satisfaction and confidence through ongoing feedback and education
Future PlansFuture Plans Increase number of coding compliance
auditors to allow for increased coding reviews and new coding associates added prior to and following ICD-10 implementation in 2014
Coding Compliance Auditors will begin dual coding of audited records and share results with coding associates during regular quarterly reviews
Coding Compliance Auditors to assist with education of ICD-10-CM/PCS for coding associates, CDI nurses, Revenue Integrity, Ancillary Departments, and all other associates identified by the ICD-10 Steering Committee as needing ICD-10 education
