Conquer Medical Coding Audits in 2024: Proactive Strategies & Best Practices





Medical coding audits are changing fast. Staying on top of these trends and following best practices can make audits less stressful and smoother.

From reactive to proactive audits


In the past, audits were unpredictable and providers often had to fix problems after the fact. Now, the focus is shifting to preventing issues before they happen:

  • Targeted audits: Payers use data to identify providers with a higher risk of coding errors, such as those with a history of mistakes or specializing in complex procedures. Be extra careful with your coding if this applies to your practice.

  • Early checks: Auditors are looking for problems before claims are even submitted. This might involve reviewing coding patterns or checking if documentation is sufficient.

  • Tech plays a role: Data analysis is becoming important in audits. Special software can find trends in coding and automatically detect errors. Use this to your advantage! Look into coding compliance software to catch errors before submitting claims.


Telehealth and stricter penalties


  • Telehealth under the microscope: With the rise of telehealth, auditors are paying closer attention to how these services are coded. Make sure your coders know the latest guidelines for telehealth billing.

  • The cost of errors: Coding mistakes can be expensive, leading to having to repay money or even being excluded from insurance networks. Knowing the potential consequences is a strong reason to prioritize accurate coding.


Conquering audits: Your guide


Knowledge is key to doing well in an audit. Here's how to prepare your practice:

  • Know the audit types: There are three main ones: internal (done by your staff), external (by payers), and government audits. Each has a different purpose and scope. Knowing the type of audit helps you respond effectively.

  • Invest in your coders: Your coding team is essential for preventing errors. Make sure they're up-to-date on coding guidelines (ICD-10-CM and CPT) and payer requirements. Consider ongoing training or certifications to keep them sharp.

  • Documentation is key: Clear, complete, and accurate medical records are essential for accurate coding. Develop and enforce standardized templates that capture all necessary patient encounter details. Regularly check to make sure your documentation standards are being met.

  • Embrace internal audits: Regular internal audits are not a burden, but a helpful tool. They allow you to identify and fix coding inconsistencies before submitting claims. This proactive approach can save you time, money, and stress in the long run.

  • Denial management: Denied claims happen, but a good denial management strategy can minimize financial losses. Train your staff to identify common reasons for denials and develop a system for appealing them properly.

  • Build bridges with payers: Open communication with payers can be very beneficial. Establish clear communication to discuss coding and billing practices. Regularly review payer manuals and updates to stay informed about their specific requirements. Payer resources and training programs can also be valuable.


https://www.allzonems.com/medical-coding-audits-trends-and-guide/



Comments

Post a Comment

Popular posts from this blog

2023 Scary ICD-10 Halloween codes For Physician

Image
  With Halloween right around the corner, be on the lookout for some of these incidents that may require new ICD-10 codes. ICD-10 CM Code W49.01 – HAIR CAUSING EXTERNAL CONSTRICTION W49 . 01XA  is a billable ICD  code  used to specify a diagnosis of hair causing external constriction, initial encounter. A ‘billable code’ is detailed enough to be used to specify a medical diagnosis. ICD-10 CM Code X99.2 – ASSAULT BY SWORD OR DAGGER X99.2 is a non-billable ICD-10 code for  Assault by sword or dagger . It should not be used for HIPAA-covered transactions as a more specific code is available to choose from below. More specific codes – 7th Character selection: The appropriate 7th character is to be added to each code from category X99 Use X99.2XXA for initial encounter Use X99.2XXD for subsequent encounter Use X99.2XXS for sequela ICD-10 CM Code R44.1 – Visual Hallucinations R44.1  is a billable ICD code used to specify a diagnosis of visual hallucinations. A ‘billable code’ is detailed eno
Read more

Medical Coding Strategies to Prevent Payer Denials

  As a former emergency department physician from the U.K., this individual was well aware of claim denials and rejections, with payers frequently withholding or reducing payments. However, it was only when his personal insurance company, denied his medical claim for a vitamin D test that he decided to delve deeper into the issue. He found it challenging to comprehend how Cigna could make such a decision when the physician reviewer had limited knowledge about his medical history. The individual had been experiencing severe pain in his hips and acetabulum, with his physician suspecting a vitamin D deficiency. Following the payer’s instructions, he appealed the denial, but unfortunately, health insurance upheld its initial decision. It was only after seeking an independent external review that finally reversed the denial. The external reviewer concluded that the test was medically necessary, considering the severity of the bone pain and the risk of bone fracture without vitamin D supplem
Read more

Medicare ASC Payment System 2024 Update: New HCPCS Codes & Changes

Image
  Get ready for new codes , updated categories , and a few surprises : Pass-through power:  Five new devices (C1600-C1603) join the pass-through party, while some old friends (C1825, C1052, etc.) say goodbye. Remember to use the January 2024 ASC code pair file for billing. Biology guides the beam:  A new code (C9794) shines a light on radiation therapy guided by biology, including PET and CT scans. Dentists get dialed in:  104 new dental codes (CDT) are now accepted in the ASC system, with special indicators for ancillary services and non-office procedures. Don't forget code G0330 for facility fees on dental rehab, but keep it separate from medical billing  charges. In short, there's plenty to keep you busy in the new year!  This update gives you more options for billing various procedures and devices, so be sure to brush up on the details to ensure smooth sailing with Medicare. Key changes: More engaging and accessible tone. Replaced technical jargon with plain language. Used
Read more