Choosing the Right Medical Coding Auditing Vendor

Choosing the right auditing vendor for medical coding is critical for ensuring accuracy, compliance, and overall efficiency in health information management operations and your healthcare revenue cycle. It is a crucial decision that can significantly impact the quality and compliance of your healthcare documentation and your organization’s overall financial health. The purpose of an audit is no longer only to measure your facility’s internal coding team’s accuracy; they can do so much more.

Before deciding on a vendor, you need to understand why you need an audit. Medical coding audits are essential for several reasons, each contributing to the overall effectiveness and integrity of healthcare operations. Conducting medical coding audits is an essential practice for healthcare providers, offering a range of benefits that extend beyond simple compliance. When choosing an auditing vendor, first decide on why you need the audits performed, and what is the main reason and goal to be achieved from the audits. This can assist you when making that final decision on an auditing vendor as to their experience and expertise. Here are the top reasons to perform regular medical coding audits:

1. Compliance with Regulations: One of the primary reasons for conducting medical coding audits is to ensure compliance with federal, state, and payor regulations.

2. Coding Accuracy/ Training: Audits help identify and correct coding errors and unbundling of services, ensuring that the codes are used accurately and reflect the services provided.

3. Accuracy of Reimbursement: By addressing coding issues, audits help maximize revenue, reduce the risk of financial losses, and ensure that billing practices are fair and accurate while also preventing undercoding, which can result in lost revenue, and overcoding, which can lead to accusations of fraud and subsequent financial penalties.

4. Improving Documentation and Patient Care: Improved documentation practices lead to better patient outcomes and more efficient healthcare delivery.

5. Risk Management: Regular coding audits help healthcare organizations identify and mitigate risks associated with inaccurate coding and billing practices. Having routine audits also goes a long way to show payors that you take the quality of your claim submission seriously and that you want to ensure coding compliance.

By conducting routine medical coding audits, healthcare organizations can ensure compliance, improve financial performance, enhance documentation quality, and ultimately provide better care to their patients. Once we know the “why” for the audit, now you can focus on choosing an auditing vendor. Here are a few key considerations and attributes to guide your selection process:

1.Expertise and Experience: Look for a vendor with a proven track record in medical coding audits with extensive experience in medical coding and auditing. Their team should include credentialed professionals with extensive experience in your specific type of healthcare sector, whether it's a hospital, clinic, or specialty practice. Check for certifications like CCS (Certified Coding Specialist), CPC (Certified Professional Coder), or CPMA (Certified Professional Medical Auditor) from recognized bodies such as the AAPC or AHIMA. The vendor should have certified coders and auditors with a strong understanding of current coding guidelines, regulatory requirements, and industry standards, as well as and payor-specific requirements. Their expertise should cover a wide range of specialties and coding systems, including ICD-10, CPT, and HCPCS. Vendors with a solid history in the industry are more likely to understand the nuances and complexities of medical coding, ensuring your audits are thorough and accurate. Accuracy is equally critical; even minor coding errors can lead to significant financial repercussions and compliance issues. Choose a vendor known for meticulous attention to detail and a robust quality assurance process to minimize errors and ensure adherence to all relevant guidelines. Check their client testimonials, and case studies or references from similar organizations to gauge their performance and reliability to assess their track record.

2.Customization and Flexibility/Support: Each healthcare organization has unique needs, your organization’s auditing or revenue cycle needs might differ from others. Ensure the vendor offers customizable solutions that can adapt to your specific requirements. They should be flexible in their approach and willing to tailor their services to align with your goals and challenges. They should also be able to provide ongoing support and training to your staff, helping them stay current with the latest coding standards and regulations. Additionally, consider the level of support they provide. Ongoing communication, detailed reporting, and training sessions can add significant value to your partnership. Partnership is a key word here. Partnering with the right vendor is creating a better team, a better department, a better section, better employees – which all improve the organization as a whole. Flexibility is also important. Are they available when you need them? Do they respond timely? Effective communication is vital for a successful partnership with an auditing vendor. The vendor should provide clear, concise reports and be available to discuss findings, answer questions, and offer recommendations. A vendor that is responsive and easy to work with can greatly enhance the overall efficiency and effectiveness of your coding audits. A good auditing vendor should be transparent about their processes, findings, and recommendations. They should provide detailed reports and be readily available to discuss results, answer questions, and offer guidance on improving coding practices. This open line of communication helps build trust and ensures that your organization can address any issues promptly and effectively.

3.Technology and Processes: In the digital age, experience in advanced technology is a must. The vendor should have a good understanding of software and tools that will ensure thorough and efficient audits within your medical record system to keep your practice compliant. Evaluate the processes the vendor uses. This will bring efficient data handling and minimize disruption to your operations. Additionally, inquire about their auditing methodology. A robust, transparent process with regular updates and comprehensive reporting is essential for maintaining high standards and addressing any issues promptly. A good auditing vendor should leverage advanced technology to enhance accuracy and efficiency. This includes the knowledge of automated coding tools, data analytics, and secure platforms for managing patient information. Validate that their processes are up-to-date and compliant with your state healthcare regulations and HIPAA. Compliance with regulations like HIPAA is non-negotiable. Ensure the vendor adheres to all relevant legal and ethical standards to protect patient information and maintain confidentiality. Assess their data security measures and protocols for handling sensitive information. A vendor with a strong track record in compliance and security will help safeguard your practice against potential legal and financial risks.

4.Comprehensive Services: A good auditing vendor should offer a wide range of services, including compliance audits, coding accuracy reviews, and education programs. There is such a broad range on types of audits and your vendor having experience in all of these types in is a definite plus. While performing your auditing needs, the vendor will then be able to point out other findings that should be brought to your attention, while offering recommendations toward improvement. Some of the types of audits include coder accuracy, DRG, risk adjustment, HCC, claim denials, provider documentation, pre-bill, payor, charge posting, medical necessity, use of modifiers, 2 midnight stay rule, observation, skilled nursing, under/over coding, and the list can go on. Education services complete your audit results. Then vendor findings should be presented to you whether it be in final summary report form or presented in an exit meeting or a PowerPoint presentation. Offering on-going education is another plus. On-boarding provider education is yet another service to look for in a vendor. Using your vendor as a resource is also a great value to have for your organization, where you can reach out for expert and reliable answers when you need them; this definitely improves your workflow.

By focusing and prioritizing on these critical factors, you'll be better equipped to select an auditing vendor that not only meets your current needs but also supports your broader long-term goals in maintaining high standards of medical coding accuracy and compliance which will ultimately enhance your overall efficiency in healthcare operations and clinical documentation, ultimately leading to better financial outcomes and patient care.

STAR Medical Auditing Services is a great choice when looking for a medical coding auditing vendor. Reach out to discuss your pain points and see how STAR can help alleviate them!