


Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
The importance of coding audit plans in limiting and alleviating errors and risks. It outlines the steps involved in developing an effective coding audit plan, including setting clear goals, appointing auditors, determining audit frequency, establishing accuracy, and setting the right size of the audit. The document also explains the differences between random and focused audits, and prospective and retrospective audits. It emphasizes the importance of having a uniform or standardized method to count and report coding variations.
Typology: Thesis
1 / 4
This page cannot be seen from the preview
Don't miss anything!



Week 1 Assignment: Compliance and Leadership HIMA- American Public University System Efficient coding audit is accomplished if it achieves to limit and alleviate errors and risks. a coding compliance procedures and policies. According to Eide Bailly article, audits exist for three main reasons. Coding audit plans exist to identify errors in documents, to protect against fraud, and to prevent money laundering. ( Rohde, 2019). Coding audit plans helps to identify code errors and the reasons behind this inaccuracies. Below I will discuss important steps that helps to achieve effective coding audit plans. When one decided to develop coding audit plan, the fist step should be to have a set and make clear of the intended goal. In this case, the goal of the audit is to identify the error and avoid making it for the future. Coding audits helps clarify whether the auditor him/herself or other issues are the cause of the problem. Having a set goal allows the auditors to have a uniform objective to follow. The second step in developing a coding audit plan is to appoint auditors. Some facilities might require both internal and external auditors to establish the audits. Once it is stablished who reviews the coding and billing: the next step is to decide how often should the audit done. According to Pugliano and Rohde most health care facilities complete internal
audits annually. (Rohde, 2019). External audit on the other side occurs frequently to ensure the coding is accurate. Completing audits as often necessary allows the area of weakness to be found and dealt with in a timely manner. Which leads us to the third step “accuracy.” Stablishing accuracy of an audit is the most important step of the entire process. Both underestimating and underestimating can cause inaccuracy. While performing an audit it is the company decision to conduct a random or focused audits. Random audit refers to audits done without focusing on identified issues. A focused audit focuses on specific issues to thoroughly correct it. Understanding these differences helps determine which areas are to be audited. It is also important to review the audit both prior and after claim is completed. Prospective audits is when review is done prior to submission. This audit helps to ensure the document are correct and completed and follows the proper coding. Retrospective audit refers to a corrective action review after the claims are submitted. This process helps correct any inaccuracy in documentation, billing, and billing guidelines. Another important process in coding audit plan is setting the right size of the audit. If smaller samples are pulled within an audit the problem could be overlooked. On the other side, larger samples can make the audit appear full of errors. That is why the right size of sample goes along with the accuracy of the audit. In order to have effective coding audit plan there should be a uniform or standardized method to count and report the coding varies. Coding modifiers such as
done and know what they are doing. It is also important to make all the staff aware action plans to correct any errors made in a timely manner. Reference Bentin, C., & Cma. (2018). 10 Best Practices for Establishing Internal Coding Audits. Retrieved from https://www.beckersasc.com/asc-coding-billing-and-collections/10-things-to- know-about-asc- coding-audits.html HealthPayerIntelligence. (2018, October 5). Preventing Provider Fraud through Health IT, Data Analytics. Retrieved from https://healthpayerintelligence.com/news/preventing-provider-fraud- through- health-it-data-analytics Rohde, S, et al. (2019). Quarterly Coding and Billing Reviews and Your Internal Audit Plan. Retrieved on December 12, 2020. Retrieved from https://www.eidebailly.com/insights/articles/2019/6/quarterly-coding-and-billing-reviews-and-your- internal-audit-plan Casto, A. B., Forrestal, E., & American Health Information Management Association. (2013). Principles of Healthcare Reimbursement: Vol. Third edition. AHIMA Press. OIG. (n.d.). Physician Relationships with Payers. Retrieved on December 12, 2020. Retrieved from https://oig.hhs.gov/compliance/physician-education/02payers.asp