Sunday, March 19, 2017

What will Trigger a Coding Audit?

By Kristen Brady

As a member of the staff might help with coding, the healthcare professional — who’s accountable to his government, as well as additional payers — have to assess the codes for accuracy before submitting them for any billing. Be on the lookout for the following red flags within your practice’s habits of coding:

  • Lack of specificity about what you’re reviewing.
  • Use of shorthand or symbols (Make certain that you have lists of what the shorthand or symbols mean in the office. Any negative symbols that don’t have elaboration aren’t considered enough documentation).
  • Use of terms like “rule out,” “probably,” “perhaps,” or “maybe” rather than symptoms and signs.
  • Missing doctor signatures for test and/or lab results ordered by the doctor assistant, physician, or nurse practitioner.
  • Upcoding on chronic, stable conditions.
  • Coding level 5 services, not preventive medicine codes for yearly physicals.
  • Excess code use.
  • Inside a group setting, inconsistent coding amongst partners and providers.

Here is how having Leading Management Solutions conduct occasional coding accuracy audits assists your healthcare organization:

  • Serves as teaching tool for employees
  • Allows you to better manage staff
  • Improves accuracy of medical records
  • Ensures that you’re updated with coding regulations and rules
  • Identifies if you’re leaving money on table
  • Keeps you from going to jail and/or paying fines
  • Assists with compliance with OIG regulations

Leading Management Solutions is currently offering a $250 discount on our Full Practice Audit service. At the end of our one-week Full Practice Audit, you will receive a comprehensive, easy-to-read report detailing how your practice performs in the areas of: Operations, Strategic Planning, Human Resources, Billing and Coding Practices, Finances, Risk and Compliance Management, Safety of Patient Care, IT infrastructure, Patient-Centered Care, and Revenue Diversification. This service includes a Coding Audit, as well as a review of your practice's financial statements with our CPA.

We are also offering our e-Assessment (Virtual Full Practice Audit) at a lower price.

Leading Management Solutions helps medical practice leaders identify ways to improve operations to increase revenue, employee engagement, and patient satisfaction. Learn more about us at

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927