Coding Compliance Audits
Independent 3rd party coding compliance audits are an essential component of a robust compliance program. Utilizing specialty-specific auditing experts ensures your organization will have any coding or documentation deficiencies uncovered. All TCN auditors are specialty-specific, possess at least one coding credential, have a minimum of 5 years’ specialty experience, and are 100% US-based. A dedicated Project Manager will coordinate the disparate auditing resources your organization needs as well as set up an efficient workflow thru either your EHR/EMR or using a cloud-based, HIPAA secure remote file sharing service. All audits will be performed in accordance with a client-specific Coding Profile where your organization’s payors, specific rules, edits and guidelines will all be taken into account ensuring that the audit results match the expectations of the entities paying the reimbursement for services rendered by your physicians.
With TCN’s education-focused audit reports, errors can be easily identified and corrective actions clearly explained. This affords our clients an easier pathway to improving their coding accuracy and honing their documentation efforts which in turn will optimize your revenue and minimize your compliance exposure.
Not only can we bolster your compliance program with auditing but we can also help you build a step-by-step compliance plan. A robust compliance plan will establish a coding accuracy target, determine a schedule based on your audit results, and layout a corrective action plan when accuracy thresholds are not met. We draw from our extensive experience working with clients in all fifty states to help build and implement the compliance plan that best fits their organization’s needs, structure, and budget.
A TCN coding compliance audit gives your organization an independent, specialty-by-specialty review of whether the codes billed for your providers’ services are accurate and supported by the documentation. Audits are useful as a baseline for a new or updated compliance program, on a recurring schedule, and whenever coding rules, providers, or coding staff change. Findings show where coding errors, missed charges, undervalued services, and documentation gaps are occurring, so compliance and coding leaders can focus education and corrective action where it is needed.
FAQs
Q1: How often should medical coding be audited?
A1: The HHS Office of Inspector General’s compliance guidance for physician practices recommends a baseline audit followed by periodic audits at least once a year. TCN generally recommends quarterly reviews instead of a single large annual review, so errors are found and corrected sooner. An additional review is also worthwhile after major coding changes or turnover in coding staff.
Q2: Who performs TCN’s coding audits?
A2: Specialty-specific auditors who hold at least one coding credential, have at least five years of experience in the specialty they audit, and live and work in the United States. A dedicated project manager coordinates the auditors your review requires.
Q3: Will the audit reflect our payers’ rules?
A3: Yes. Each audit follows a client-specific Coding Profile that accounts for your payers and their rules, edits, and guidelines, so findings match the expectations of the organizations paying your claims.
Q4: What does a TCN audit report include?
A4: TCN’s reports are education-focused. They identify errors, explain the corrective action for each, and include coding and documentation feedback, so your coders and providers can improve accuracy rather than simply receive a score.
Q5: Can TCN help us build a coding compliance plan?
A5: Yes. TCN can help you set a coding accuracy target, schedule follow-up reviews based on your audit results, and define the corrective action to take when accuracy thresholds are not met.
Q6: Are there minimums or long-term contracts for audits?
A6: No. TCN does not require minimums, exclusivity, or long-term contracts. Audits can be performed through your EHR/EMR or a HIPAA-secure cloud file-sharing service.
Solution Highlights
- Experienced, certified, single-specialty auditors
- Uncover missed opportunities
- Minimize risk, denials, penalties and/or fines
- Education-focused comprehensive reports
- Dedicated project management included
- Coding and documentation feedback
