Medical Coding Quality Improvements Through External Audits
Rural health system in western United States comprised of two critical access hospitals, two pharmacies, an outpatient health clinic, and a skilled nursing facility.
New leadership at the hospital was interested in implementing an external coding audit program to ensure staff were delivering compliant, quality coding and to identify opportunities for coding education as a result of the audit findings.
AQuity’s Coding Audit Leadership, in partnership with the client, developed a plan to perform external coding audits on an annual basis. By taking a small sampling across all patient types, inclusive of both hospital and physician billing, AQuity auditors performed a code-over-code retrospective review to identify the overall coding accuracy score, documentation deficiencies, query opportunities, and provide professional recommendations. They also identified areas for additional coder education, billing and rebilling opportunities, and significant trends as part of the audit findings.
The AQuity Coding Auditor achieved::
- Providing education and increasing coders’ skillset by discussing audit findings
- Process changes making hospital more efficient in using their current EMR and encoder
- Identifying opportunities for payment reimbursement
- Ongoing and immediate, daily communication answering coding questions and assisting with requests
- Moving to quarterly audits for increased education opportunities
“I had AQuity perform a coding audit for our facility, and I was more than satisfied with the quality of their work and all the education materials they shared with me and my group of coders. They also have a great leader, Mary Tomak, as their Director of Coding Quality and Education as well. Mary and her team were so easy and great to work with. They all really embrace the open communication mentality.”
– HIM Director