Prepare your coding department to perform effective audits

Why This Topic Matters

Organizations use coding audits to identify documentation and coding issues that can affect claims accuracy, compliance, and revenue cycle performance. The article is relevant for teams evaluating audit priorities, staffing, and educational needs.

Article Sections

1. Introduction to coding audit planning

   Introduces the purpose of coding audits and the planning factors that affect audit scope and staffing. It frames audits as part of both compliance and revenue integrity efforts.

2. Primary goals of coding reviews

   Summarizes the broad objectives of coding review activities. The section focuses on education, revenue integrity, and claim accuracy.

3. Assessing coding accuracy and coder competencies

   Describes the general areas auditors may evaluate when reviewing coding accuracy. It addresses documentation review, sequencing, guideline awareness, and capture of clinically relevant conditions.

4. Leveraging the coding review

   Explains how audits can also function as compliance and record-integrity reviews. The section covers broader documentation and operational issues that may surface during review.

5. Presence of documentation conflicts

   Discusses how conflicting information in the record can affect integrity and may signal process concerns. It highlights why auditors pay attention to consistency across documentation sources.

6. Use and misuse of copy-forward functionality

   Covers concerns related to reusing prior documentation in current records. The discussion places this practice in the context of compliance oversight and record quality.

7. Untimely documentation

   Addresses timing issues in documentation creation and how they may affect audit findings. The section notes that clustered or delayed documentation can raise compliance questions.

8. Lost clinic data integrity and revenue integrity opportunities resulting from unanswered queries or queries not issued

   Describes the audit implications of incomplete query workflows. It explains why unanswered or missing queries can affect specificity and downstream reporting.

9. Incorrect charges

   Reviews the audit value of identifying charge capture problems. The section distinguishes between missing and incorrect charges as broad audit categories.

10. Chargemaster-related issues

    Covers issues that may appear in charge systems and denial-related reviews. It discusses charge duplication, missing charges, and charge description maintenance concerns.

11. Validation of the hours for observations and infusions

    Discusses audit review of time-based services and related documentation elements. The section emphasizes education opportunities for staff involved in documentation and billing workflows.

12. Observation timing and order requirements

    Explains how observation timing is tied to documented orders and status changes. The section provides general context for auditing observation-related records.

13. Conclusion

    Closes by restating the overall objective of coding audits. It emphasizes completeness, accuracy, and documentation integrity as central audit outcomes.