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Learn More“A well-run coding audit can go a long way towards improving operational efficiency — if it’s done properly and with an eye toward all the goals it should achieve. That’s why planning and preparing are major steps that shouldn’t be rushed,” says Lisa Marks, RHIT, Coding Audit Director of nThrive.
According to Marks, there are some basics every audit should cover:
“There’s a lot to think about and a lot to consider in preparing for a coding audit,” she says. “So first determine the primary goal. One of the most important tasks to an audit is to determine what your primary goal is — and communicate this to the auditor. This will help drive the other audit-preparation decisions and set you up to have a successful audit that meets your needs and expectations.”
Goal setting drives audit efficiency and produces better outcomes
To get there, she says, ask some basic questions: What are the primary goals? What do you want to learn? What do you want to achieve from a coding audit?
“For example, do you want to determine the overall accuracy of coding? If yes, do you want to determine this across the entire patient population, or just across the Medicare population? Answering this can help drive decisions regarding which records are selected for the audit,” she explains.
Other areas to explore:
“Determining your primary goal can drive decisions on the audit frequency, the scope, the volumes, and on the charts-collection methodologies,” Marks adds. “For example, if you wanted to cover all of these goals, a small, one-time audit of 30 to 40 encounters is not going to cover it. You're going to need a larger volume reviewed and would likely need to set up several separate audits to cover the various different goals.”
Once those goals are set, it will be time to explore the audit’s scope so that it can be managed efficiently. That will mean assessing whether it’s an inpatient or outpatient audit, or perhaps both, depending on the identified need and information being sought. Once that population group is identified, then it’s time to look at what types of services to be included in the review, as well as an understanding of the complexities around any or all of those services. The same goes if provider education is to be included as part of the analysis and results, because educating providers is very different than educating coders, Marks notes.
Determining the frequency or audits and reviews will vary by facility, and certainly by service. Different organizations choose different intervals, from daily to monthly, quarterly, semiannual and even annual, depending on what’s being assessed. Whatever the case, identifying clear goals and then creating a targeted list of ideal outcomes will help any audit achieve the desired outcome and provide the vital information a provider needs to ensure the best patient care alongside maximum operational efficiency.
For information on nThrive’s many coding programs and solutions, click here.
Bio:
Lisa Marks, RHIT, CCS, is the Coding Audit Director of nThrive. She leads a 35-member coding audit division, and routinely lends her expertise to the development of educational seminars and learning materials that span all aspects of the coding-audit process.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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