Coding Audits and Record Analysis
AQuity audits and record analysis projects target specific coders or service areas for a compliance focused assessment based on KPI measures.
Coding Audits and Record Analysis Solutions
AQuity uses an investigative approach to identify core issues that target audits from a compliance, coding quality, and workflow efficiency perspective. Audits and reviews can target specific coders or service lines, new team members, or any group that needs assistance based on KPI measures. Our approach includes detailed audits and analytics leading to recommended supplemental training and process adjustments.
Best Practices
Disciplined medical coding audits and record analysis are critical activities required to ensure the success of accurate and compliant coding practices. To maintain positive ongoing results, the AQuity Revenue Integrity team adheres to the following best practices:
Define Audit Goals and Objectives
Clearly defined goals and objectives help to ensure coding accuracy and compliance with department/specialty specific coding guidelines. Audits help identify areas for improvement or added monitoring needs based on billing and reimbursement patterns.
Establish Audit Criteria
AQuity auditing criteria extend on established department practices to include industry standards (AHIMA and AAPC coding guidelines) and all relevant national and local regulatory requirements. Orienting the entire team on such comprehensive consolidated benchmarks ensures accuracy, compliance, and minimized denial rates.
Conduct Random and Targeted Sampling
Consistent use of a combination of random and targeted sampling methods helps ensure a representative sample set for all coder/specialty combinations as well as specific areas of concern for high-risk, high-value cases.
Engage Expert Auditors
AQuity’s experienced and certified professional auditors have a thorough understanding guidelines, regulations, and the clinical documentation requirements needed to achieve optimized justifiable billing. Each member brings strong analytical skills and attention to detail.
Review Documentation
Statistically valid sampling of assigned medical records are analyzed thoroughly to ensure the documentation supports all assigned codes. AQuity auditors look for complete, accurate, and charge level justified documentation details for assigned codes. Evaluations can be completed on physician notes, operative reports, diagnostic tests, and other relevant documents.
Assess Coding Accuracy
Audits for accuracy are more than simply confirming the defined codes are properly justified in the documentation. Accuracy audits also look for any upcoding/down coding scenarios driven by documentation details that may or may not properly reflect the severity of the patient’s condition and the complexity of the procedure(s) performed.
Verify Compliance
Evolving Medicare audit requirements and the associated penalties for non-compliance have made compliance verification an exceptionally critical component of any coding audit effort. All cases need to be checked to verify if the coded records adhere to the relevant guidelines for ICD-10-CM/PCS, CPT, and HCPCS. AQuity evaluates if the coding is consistent, appropriate, and fully supported by the documented clinical details.
Provide Education and Feedback
A major competitive differentiator of the AQuity Revenue Integrity team is the quality and specificity of our constructive feedback to our client’s staff based on the audit findings. We identify areas of improvement and provide the associated education and training to address knowledge gaps, coding errors, and/or processes to root out documentation deficiencies. We regularly communicate audit results to relevant stakeholders, such as coding managers, physicians, and compliance officers with the goal of improving performance rather than penalizing errors.
Implement Corrective Action Plans
Develop corrective action plans to address identified issues and prevent future coding errors or compliance breaches. Establish protocols, guidelines, and ongoing monitoring processes to ensure sustainable improvements in coding accuracy and compliance.
Maintain Audit Documentation
Positive, supportive corrective action plans are another key feature of AQuity Revenue Integrity team audits. We provide detailed records of the audit findings, corrective actions taken, and follow-up educational/support activities. This documentation serves both as evidence of compliance efforts, but also for future reference, internal reporting, and new team member education.
Speak with an AQuity Audits and Records Analyst
AQuity is a nationally recognized leader in Coding Audits and Records Analysis. Contact us today to discuss your objectives and learn how we can help.
Key Differentiators
- Experienced consultative strategic advisory solutions that address financial pitfalls related to coding, charging, billing.
- Proven process analytics and management services for inpatient and outpatient denials to ensure a secure and sustainable revenue cycle.
- Detailed process evaluation and changes implementation that target training, and ongoing monitoring to ensure peak performance.
- Charge master review to identify possible inaccurate revenue and CPT code assignments leveraging utilization reviews and revenue patterns.
- Thorough examination of charge accuracy for high-cost, high-risk, and high-volume service lines to avoid a cascade of costly mistakes.
- Comprehensive full workflow cycle review with focus on quantifiable, measured, and monitored results to ensure optimal justifiable revenue and compliance.
- Multi-department RCM orchestration to create a connected workflow that resolves process gaps and promote consistent cash flow.
Areas of Coding Audits and Record Analysis
Total Quality Audits
Examine, identify problematic areas related to coding, documentation, quality;
Targeted Reviews
New physician or targeted physician quality review, physician practice merger/acquisition, System Integration.
Pre-Bill Audits
Pre-bill function, inclusive examination including MSDRG, Hospital Acquired Condition (HAC Indicators), Discharge disposition and Charge capture assessment, performed prior to claims submission.
System Integration Advisory
Consultative services for Go-to-live EPIC implementations.
Speak with an AQuity Audits and Records Analyst
AQuity is a nationally recognized leader in Coding Audits and Records Analysis. Contact us today to discuss your objectives and learn how we can help.
