How to Avoid a Medical Coding Audit

by | Published on Nov 7, 2014 | Medical Coding

Medical Coding
Share this:

Error-free medical coding is crucial to ensure accurate physician reimbursement. With the rising incidence of healthcare fraud, abuse, and waste, Medicare and private payers are scrutinizing coding errors more closely. Coding mistakes can attract costly audits. Adhering to best practices in coding reduces the hassle of audits, improves patient care, and enhances efficiency.

How not to Trigger a Medical Coding Audit

  • Avoid Coding Mistakes – Check whether EHR-assigned codes are accurate. Experts recommend that physicians follow the “SOAP” (subjective, objective, assessment and plan) note approach, which offers guidelines to effectively document a case for accurate coding. The documentation of the present illness must be based on patient’s narrative on that day, and should not be copy-pasted from the previous visit if it has no relevance to the problem. And most importantly, before finalizing, the physician should read the record to ensure it is appropriate and consistent for the visit.
  • Accurate Documentation – The area where most providers fail in documentation is regarding the history of patient illness. They should not rely on the patient as the patient can omit important information leading to the assignment of wrong codes. Physicians should avoid the usage of “Routine” for a main complaint as this is a flag for auditors. ‘Routine’ may be considered unnecessary. So it is important to describe the purpose of the patient visit such as ‘here for an X-ray’.
  • Pay attention to the Time Element – If the time spent with the patient is within the service range area of the patient’s chart, there is nothing to worry about. However, if extra time is spent with the patient, it is important to justify that. Physicians may spend extra time to explain treat options, risks and benefits, patient education and counseling, and so on. Make sure this is specified in the documentation.
  • Avoid indiscriminate use of EMR cut and paste function – Using the EMR cut and paste function to copy information pertaining to one visit or from one record to another can end up in serious errors, even those that cannot be corrected, all affecting patient care. This could result in copy paste of information that is no longer relevant or copying of unnecessary information, which can be confusing and result in coding errors. Mistakes in documentation caused by using these shortcuts can cause violation of HIPPA rules, attract payer audits, and expose the physician to risk of fraud and malpractice charges.
  • Perform Random Mock Audits – Based on the same criteria as a Medicare auditor, carrying out random mock audits can give great advantage by providing awareness about what can be expected from an audit. A mock audit can identify problems like overcodes as well as undercodes and help in improving the documentation and coding, thus the potential for errors. When you perform a mock audit, look for billing or coding inaccuracies, lack of supporting documentation, and duplicate claims.

The rise in the volume of patients and need to focus on care is leading more and more physicians to rely on professional medical coding services. Outsourcing results in cleaner claims, improved office efficiency and lessens workload. Professional coders are well versed in CPT and ICD codes and can ensure accurate coding for protection from audits, while maximizing reimbursement. The mock Risk Adjustment Data Validation (RADV) audits provided by reliable medical coding companies help confirm reported diagnoses and identify ICD-9-CM coding errors.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

More from This Author