Coding Audits

HCTec provides coding audit services that help healthcare organizations successfully meet compliance and regulatory requirements, minimize financial risk, and manage their revenue cycle. Our inpatient, outpatient, and physician coding review services are designed to help facilities improve code reporting in order to:

  • Maintain compliant reimbursement
  • Achieve optimized case mix indices
  • Reduce claim denials
  • Provide coder education

General Audit Specifications

HCTec’s Coding Auditors will validate ICD-10-CM/PCS coding, MS-DRG, and APR-DRG accuracy and review the entire medical record for each case, including trends and patterns by Major Diagnostic Category, MS-DRG, APR-DRG, principal diagnosis, secondary diagnoses, physician queries, coding variances not impacting MS-DRG, discharge disposition, and coder statistics.

Our Coding Auditors adhere to the guidelines for coding and reporting that have been developed and approved by the Cooperating Parties for ICD-10-CM/PCS: American Hospital Association, American Health Information Management Association, Centers for Medicare and Medicaid Services, the National Center for Health Statistics and CPT: the American Medical Association.

As part of our commitment to compliance and data quality monitoring, HCTec has established standards of performance for HIM practices concerning coding compliance and confidentiality of health information administered through our internal compliance program. Our experience developing our own Coding Compliance Program, as well as working with clients across the nation, provides the framework for us to assist you with your own internal plan through coding review services.

Audit Methodology

Our methodolgy for excellence is what sets HCTec apart. Clinical documentation will be assessed to determine if the code assignments are supported by documentation in the medical record. HCTec will then provide a coding review report, which will include an executive summary with net financial impact based on Medicare payment rates provided by the facility. The detailed coding findings with corresponding suggested recommendations will be provided for all medical record coding variances.

HCTec will conduct an exit session upon completion, where we will review the coding audit findings and recommendations with HIM management and coding staff. When the review is complete, we will provide reports that reflect our findings and recommendations. We will make recommendations for focused education that is needed based on our review outcomes, as well as ongoing educational opportunities that can be incorporated in to the facility coding education plan.

HCTec Audit Team Credentials

HCTec strives to provide service that exceeds client expectations. We customize our services and processes to make each client’s needs the core of our relationship. The HCTec team includes Coding Auditors who collectively have an average of 20 years of HIM experience and are committed to delivering high-quality results. These HIM professionals have significant experience ranging from critical access hospitals to complex academic medical centers, with proven experience in coding, payment methodologies, and CDI operations.

In addition, our Coding Auditors and ICD-10 Project Managers have completed ICD-10 training by an AHIMA-approved trainer and many are AHIMA-approved ICD-10 trainers. Our team also includes trainers with experience in physician coding and education who conduct all on-site physician education sessions. They are fully credentialed, with many certified in several different areas, including coding, HIM, and CDI. Their Coding credentials include CCS, CCS-P, CPC, and CPC-H; their HIM credentials include RHIA and RHIT; their CDI credentials include CDIP and C-CDI.

Let’s Talk About Coding Audits

To learn more about our Coding Audits services please contact us here.

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