tci Medicare Compliance & Reimbursement - 2007 Issue 42
PART B MYTHBUSTER: Are Your Audits Making Your Coding Better Or Worse?
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Article Overview
This premium article addresses how coding audits should be performed for physician practices, with emphasis on evaluation and management documentation, surgery claims, and the differences in audit methods used by carriers. It is aimed at coders, billers, physician educators, auditors, and practice managers who want to understand how audit quality can influence coding accuracy and review outcomes. The article provides broad guidance on auditor qualifications, documentation review, and the importance of aligning audit methods with applicable carrier expectations.
Why This Topic Matters
Audit quality can influence whether coding reviews support accurate documentation assessment or create inconsistent findings. For practices, understanding the general audit framework helps reduce confusion when multiple review methods or documentation standards are involved.
What You Will Learn
- What qualities an auditor should have when reviewing medical charts
- How audit approaches can vary by carrier and documentation method
- Why understanding evaluation and management documentation is important in audits
- What general knowledge auditors need for surgery claim review
- How audit findings may be used by physicians and practices
Who Should Read This
- Coders
- Billers
- Physician educators
- Auditors
- Physicians
- Practice managers
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