Related Experiment Videos
Avoiding audits by benchmarking your E/M coding.
1LAS Practice Management and Coding Services, LLC, P.O. Box 4624, Breckenridge, CO 80424, USA.
The Journal of Medical Practice Management : MPM
|October 7, 2005
Summary
Accurate medical coding ensures prompt insurance payments. Practices should regularly audit clinical records and documentation against benchmarks to prevent claim denials and costly payer reviews.
Area of Science:
- Healthcare Administration
- Medical Billing and Coding
- Health Information Management
Background:
- Prompt payment of medical claims hinges on accurate coding practices.
- Payers retain the right to conduct post-payment audits, which can be burdensome for practices.
- Understanding the coding and payment lifecycle is crucial for practice financial health.
Purpose of the Study:
- To provide an overview of the medical coding and payment process.
- To emphasize the importance of proactive auditing and documentation in medical practices.
- To offer strategies for mitigating risks associated with payer audits.
Main Methods:
- Review of the medical coding and payment process.
- Discussion of payer audit procedures and their impact on practices.
- Recommendation for periodic self-auditing of clinical records.
Main Results:
- Inappropriate coding can lead to delayed payments and claim denials.
- Payer audits are resource-intensive and can negatively impact practice operations.
- Self-auditing against benchmarks helps identify coding discrepancies.
Conclusions:
- Regular internal audits of clinical documentation and coding are essential.
- Comparing practice coding distributions with national or specialty benchmarks is advised.
- Ensuring coding levels are consistently supported by thorough documentation is critical for compliance and revenue cycle management.