How to Code a Compliance Audit

Physicians and hospitals must place the proper medical coding within patient records, which represent the patient's illness, treatment given and any follow-up care. These codes consist of ICD-9 codes and current procedural terminology (CPT) codes. This routine coding enables insurance payers -- such as Medicare -- to send out compensation for services that physicians render.



Unfortunately, improper codes can have money taken away from the physician's practice due to negative findings from external audits. To ensure that the patient's medical records show the appropriate codes, conducting a compliance audit allows an evaluation of your practice's coding techniques to see if they meet required standards.

Instructions

• 1

  Assess how your coding techniques compare to Medicare's national averages concerning other specialized physicians. Conduct an in-house audit by having a staff member pull every fifth chart from your patient list for a week until gathering 10 charts. This allows for a random selection process. To see if there are any types of medical coding trends, have the staff member pull charts from visits taking place at a specified time. Choose someone from your practice to give an unbiased auditing review who will use the same guidelines that Medicare and private insurance auditors will use.

• 2

  Review the compliance auditing results. Note the improper use of CPT codes, any incorrect diagnosis that does not indicate a medical necessity, any trends and any deficiencies. Gather staff members for a meeting to talk about the audit results. Provide coding reference sheets in every exam room to prevent further discrepancies.

• 3

  Correct coding errors by creating an ongoing reporting and feedback system for staff. Record error rates or inaccurate and missing documentation trends. Allow for helpful feedback on how to handle such issues to prevent future undercoding, which could lead to medical insurers not fully compensating the practice. Repeat coding audits to monitor the progress of improvements and provide status reports to staff concerning all corrected and continuing problems.