Establish a process for conducting targeted coding audits

Why This Topic Matters

Targeted audits help organizations direct limited review resources toward areas with the greatest compliance, denial, documentation, and training impact. This makes it easier to monitor coder performance, support consistent documentation practices, and identify opportunities for education and process improvement.

Article Sections

1. Audit planning and staff roles

   Introduces the purpose of focused auditing and the responsibilities of coding leadership and auditors. It also discusses how audit programs fit into broader compliance and performance monitoring efforts.

2. Choosing topics to audit

   Reviews general factors that can help determine which subjects are most appropriate for review. The section emphasizes relevance to operations, monitoring of practice changes, denial trends, and performance assessment.

3. Reviewing new coders and clinicians

   Covers how organizations may approach early monitoring of newly hired coders and clinicians whose coding may flow directly to claims. It also addresses orientation, credentialing-related documentation, and performance feedback.

4. Building a coding compliance plan

   Discusses collaboration with medical staff leadership and providers when developing a compliance program. The section focuses on gaining input, support, and shared ownership for review activities.

5. Other sources of review topics

   Describes how denial patterns, prior audit findings, and problem areas in documentation or service reporting can help generate future audit topics. It also notes the value of using audit results to support education and management reporting.

6. Limit reviews

   Explains the need to narrow the audit scope when many subjects could be reviewed at once. The section also covers applying reviews across staff and activities and coordinating an internal audit calendar.

7. Examples of additional content for the coding compliance plan

   Provides sample planning concepts for internal and external reviews, including frequency, sample sizes, and review thresholds for different coder groups. It also outlines broad focus areas used in audit scoring and reporting.

8. Audit focus

   Summarizes major categories that may be included in targeted reviews. The section includes data transfer, documentation integrity, and regulatory considerations tied to current oversight priorities.