Internal Coding Auditing Programs

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Internal Coding Auditing Programs. Gloria Litton, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer. The Need For Coding Audit Programs. The OIG Compliance Program Guidance for Hospitals states that "an ongoing evaluation process is critical to a successful [coding] compliance program - PowerPoint PPT Presentation

Text of Internal Coding Auditing Programs

  • Internal Coding Auditing ProgramsGloria Litton, RHIA, CCSAHIMA Approved ICD-10-CM/PCS Trainer

  • The Need For Coding Audit ProgramsThe OIG Compliance Program Guidance for Hospitals states that "an ongoing evaluation process is critical to a successful [coding] compliance programThe data provided by coders is invaluable to an organization in order to provide appropriate data collection and safeguard against the increasing level of external scrutiny of the coded data.

  • The Benefits Of AuditingTo keep performance and compliance on trackProvide ongoing feedback on coding staff performance Improve quality of existing coding staff Identify missed opportunities Decrease delays in dropping recordsDecrease DNFB

  • Factors Leading To An Enhanced Coding Audit Program New coding associatesAssociate turnover/retirementAdditional or expanded hospital servicesFocus on Revenue Cycle and development of more stringent DNFB goalsIncreased external re-review activitiesDRG validation requests from payersRAC/Other regulatory reviewsIncreased organizational quality review programsCore MeasuresIncreased payer denials and rejectionsPreparing for ICD-10 implementation

  • Mary Washington Healthcares Internal Auditing PlanWhere we startedOne Auditor/EducatorChart reviewsDRG Validation Reviews from internal and external requestorsQuarterly External AuditsEach patient type was reviewed once a yearLimited Outpatient ReviewsFocus was on inpatient reviewsLimited time to complete reviews on all patient types

  • How We ProgressedFocus on coding quality AND productivityHired additional coding compliance auditorsIncreased coding reviews for each coderDeveloped a coding review schedule to include all coders and all patient service typesIncreased focus on outpatient codingMaintained our quarterly external review scheduleEach patient type is reviewed on a quarterly basis by an outside coding auditing organization

  • Coding Associates18 coding associates10 inpatient coders4 outpatient codersCharge entry for IR and Cardiac Cath4 emergency room codersCharge entry for ER services and level of care4 coding auditors2 Inpatient AuditorsInpatient reviews/RAC reviews/ DRG Validation ReviewsInpatient reviews/Internal Quality Reviews2 Outpatient AuditorsOutpatient reviews/Denials and rejectionsEmergency Room reviews/Auditing software and system testing

  • Coder ReviewsIncreased the number of individual coder reviewsQuarterly reviews for each coderMinimum of 30 records per reviewRandom selectionPatient Service TypeRe-reviews for audit scores less than the coding accuracy standard of 95%Additional review of 30 records within one month of the initial reviewIncorporated accuracy scores into annual performance evaluationsCoding accuracy scores are 35% of total job competencies on annual performance evaluationsCoding standards set to match the performance evaluation categories (meeting expectations, exceeding expectations, and needs improvement)

  • Auditing ToolsImplementation of electronic auditing softwareAutomatically uploads ADT information and codes from abstracting softwareAuditor randomly selects 30 charts from the that monthlyCodes from audit results are entered into the auditing softwareDevelopment of audit result toolsAudit Review Schedule developedAudit Review Packets are created for each reviewAudit Summary SpreadsheetReports from individual records are generated

  • Second Level Review ProcessIncreased internal quality reviewsCore MeasuresReadmissionsDeveloped an automated review processDeveloped an internal coding review emailRecords referred from clinical quality review programs are emailed to the email accountMonitored by coding compliance auditorReviews and responds to requestors Automated a pre-bill review workflow processCoders cannot finalize records that meet certain criteria Records can only be finalized by the coding compliance auditors

  • ResultsMet the 95% coding accuracy standard for 2012 and year-to-date for 2013Every coder was reviewed internally for each quarter in 2012 and once externally by coding auditing vendorIncreased coder satisfaction and confidence through ongoing feedback and education

  • Future PlansIncrease number of coding compliance auditors to allow for increased coding reviews and new coding associates added prior to and following ICD-10 implementation in 2014Coding Compliance Auditors will begin dual coding of audited records and share results with coding associates during regular quarterly reviewsCoding Compliance Auditors to assist with education of ICD-10-CM/PCS for coding associates, CDI nurses, Revenue Integrity, Ancillary Departments, and all other associates identified by the ICD-10 Steering Committee as needing ICD-10 education

  • Thank YouQuestions?Contact InformationGloria.litton@mwhc.com(540) 741-1650