Why Medical Coding Audit is Vital for Every Medical Practice?

Why Medical Coding Audit is Vital for Every Medical Practice?

Medical Coding Audits are of utmost importance in maintaining the sustainability of the medical institutions. They are of fundamental importance. Just like we keep audits of all the financial expenses of an industry or a household, the same is done with the medical records by the professional medical coding auditors. Here are some of the benefits and advantages of medical coding audits that make them vital for every medical practice: –

1- Discover Problematic Trends

While auditing, auditors sometimes find many unusual and problematic trends like the under and upcoding, in which the data and records are rendered and manipulated to gain unfair advantages of some services. Upcoding means representing data to more expensive processes than usual and vice versa. Various documentation errors are unearthed while auditing, like fake tax and insurance claims. Hence auditing helps in breaking these frauds. Sometimes, the coding and billing process is not up to par with the current medical standards. This helps to check the accuracy of records.

2- Prevent Compliance Headaches

Compliances are one of the most important reasons for auditing. All the medical records are subject to compliances like the insurance policy, tax benefits, etc. And if the relevant authorities find any ambiguity, then surely the auditing wrath can fall on the medical institutions. That’s why medical institutions prefer pre auditing. Because if they are found to be indulged in unlawful activities, their license can be terminated.

3- Improving Accuracy

Accuracy also matters a lot. For decades, it has been seen that the accuracy in medical records coding is way lower. It was fifty-five percent in 2016 and improved slightly to sixty-one in 2017. It is even lower in the emergency department. They are of fundamental importance because they affect the claim process of insurance for the patients and are subject to various compliances. That’s why audits are necessary to resurface the mistakes. It has also been noticed that the quality of the medical record coding is not up to par with the industry standards, and various poor documentation is seen while auditing.

4- Protecting the Bottom Line

Medical instruments and medicines are subject to government subsidies. But the government only releases the subsidy when proper documentation and records are sent to them in due time. But since the medical coding is of poor quality, the claims are rejected or denied, making the hospitals lose extra money that they can not afford sometimes. It also takes extra human and machine efforts to correct those rejected claims and send them again to get reimbursement. So, auditing helps track these mistakes and correct them in the least possible time.

5- Providing Coder Education

Auditing also helps the medical staff to learn the best practices to maintain the coding record. When the auditor is checking in the records and showing them the mistakes, the medical staff learns a lot, and they avoid making these mistakes in the future. Thus all the purposes of auditing are served.

These were some of the most important advantages and benefits of medical coding audits. Apex MedPro offers a free audit service worth $1500. Please fill up the form and give us a chance to Audit your practice.