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Why ‘Audit’ Isn’t a Four-Letter Word When It Comes to Medical Coding


Just the sound of the word “audit” may leave some leaders feeling uneasy, but the value of an effective medical coding audit strategy can’t be underestimated for healthcare organizations of all sizes and specialties. It not only provides an opportunity to ensure your practice or healthcare organization is following important regulations and guidelines, but it can actually enhance or improve your financial performance and revenue cycle, too. Most importantly, focusing on accurate and thorough coding can lead to improvements in patient care that come with better documentation.

Organizations that implement a routine compliance plan for medical coding typically employ both internal and external resources. That’s because this team approach can provide a “checks and balances” model that takes advantage of in-house knowledge and provider relationships with an external vendor’s expertise and fresh perspective. If you haven’t already, here are a few reasons a comprehensive medical coding audit plan is critical for any successful healthcare organization.

    Compliance is critical. Fraud and abuse are words commonly thrown around when discussing compliance with medical coding guidelines and regulations. While most organizations strive to do the right thing, the cost of making errors in medical coding can be staggering, costing millions of dollars – not to mention the PR nightmare that goes along with being called out for fraudulent practices.

    Reimbursement matters. Improper coding can have a significant impact on your organization’s bottom line. While there are surely some organizations that “overcode,” more commonly, providers and organizations tend to undercode by not adequately capturing the level of services delivered to patients. This can leave reimbursement on the table for care that was delivered, but not adequately documented and/or coded.

    Practice makes perfect. The continuous evaluation and refinement of any process will lead to improvement. Having both internal and external resources evaluating your organization’s coding processes can help identify common errors and provide opportunity for improvement – both for your coding team and your providers. Those organizations that take this information and develop a continuous feedback loop to inform and educate their teams will continue to enhance their performance.

    There’s value in getting it right the first time. Accurate medical coding leads to a reduction in denials and delays in payment – both of which can have a significant impact on your revenue cycle. Organizations with a sound coding audit strategy are more likely to get their claims submitted accurately and paid the first time around – which can have a long-term impact on the organization’s fiscal health.

    It’s the right thing to do. Whether it’s the delivery of patient care or back-office administrative functions like medical coding, accuracy in healthcare is everything. Documentation and coding are not only important to the organizations delivering care – it’s even more important to the patients you serve. Getting these important elements of the care experience right can help reduce healthcare costs, patient frustration and most importantly – can enhance the delivery of exceptional patient care.

Do you need help making sure your medical coding audit strategy is where it needs to be? GeBBS Healthcare Solutions has more than 2,000 exceptional medical coding experts and a wealth of experience supporting organizations that need help with their audit strategy. To learn more click here.

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