Medical Coding Audits
Pro Fee, Outpatient, and Inpatient code assignment accuracy reviews to validate justifiable reimbursements.
AQuity audits ensure the highest level of coding accuracy and compliance while also identifying opportunities for documentation and/or coding process improvements. The goal is to evaluate coding accuracy based on industry guidelines, rules, and regulations. All findings and educational concepts are included in the findings with supportive justification, citing official sources.
All audit personnel are tested in proficiency prior to hire and ongoing throughout their tenure with AQuity to ensure that the level of competency is above industry standards.
- Auditors with diverse credentials
- Diverse workforce (domestic and global) within a minimum requirement of 5 years clinical coding and auditing background
- Comprehensive knowledge across multiple service types
- Facility (acute care, CAH, University Medical Systems, Trauma Centers, IP Psych, IPRF, SNF, LTAC, IVR, Cardiac Catheterization)
- Professional billing (consultations, multi-specialty, Inpatient rounding)
AQuity Coding Quality audit approach is client driven audits, diverse staff credentialing, dedicated audit team and comprehensive knowledge of coding across several service types. AQuity clinical coding and audit approach reduces risk and enhances financial impact.
- Customer Driven medical coding audits (code over code or reimbursement focused)
- Clinical Coding Audit approach
- Monthly peer and audit leadership audits on all auditors
- Subject matter expert auditors matched based on customer needs.
- Dedicated auditors with assigned back up auditors for each project.
- Dedicated audit project manager
- Aquity auditors are provided monthly educational opportunities (CEU’s) to stay abreast of changing code sets, regulations, and enhancement of skillset.
- Personalized education based on customers’ needs
- Proprietary Audit tool provides:
- a single platform to conduct coding analysis
- real time feedback for coders and operational management
- error trend analysis for compliance risk and financial impact
- increased auditor efficiency
- Customized and standard dynamic reporting & quality dashboards
AQuity provides standard and customized medical coding audits to meet any customer’s needs.
- Concurrent medical coding audits
- Pre-bill medical coding audits
- Training & Educational medical coding audits
- Retrospective (billed) medical coding audits
- Compliance medical coding audits
- Focused medical coding audits
- Mortality compliance audits (experience utilizing Vizient and Elixhauser comorbidity index)
- Clinical documentation improvement/coding impact audits
Audit Types
- Retrospective or Prospective/Pre-billed Claims
- Random or Targeted
- Code for Code
- Full Record Audits
The Detailed Audit Findings Report confirms identified error trends and recommendations for improved documentation and educational needs.
Audit objectives include:
- Identification of coding compliance areas of risk
- Identification of coding errors with potential impact on revenue
- Identification of clinical documentation improvement initiatives
- Identification of trends and educational opportunities
- Identification of query process improvement opportunities