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What is billing auditing?

Billing audit: A process to determine whether data in a provider's health record, and/or by appropriate and referenced medical policies, documents or support services listed on a provider's bill. Providers conduct such audits either through an internal control process or by hiring and external audit firm.

What are the types of coding audits?

Coding audits can be retrospective, which is a review of submitted claims, or prospective, an analysis of prebilled claims. They can also be random, targeted, or a mix of both, and a code-for-code or full-record analysis.

How do you conduct a coding audit?

Step 1: Determine What Types of Records to Review. Step 2: Determine Volume of Records and Frequency to Review. Step 3: Analyze Results. Step 4: Corrective Action and Training. Step 5: Get a Fresh Set of Eyes. CMS and the OIG recommend regularly having your coding audited by an outside reviewer.

How do you conduct a coding audit?

Step 1: Determine What Types of Records to Review. Step 2: Determine Volume of Records and Frequency to Review. Step 3: Analyze Results. Step 4: Corrective Action and Training. Step 5: Get a Fresh Set of Eyes. CMS and the OIG recommend regularly having your coding audited by an outside reviewer.

What is the main type of audits coding compliance performs?

Coding Outcomes Based on Method The two main coding audit methodologies utilized to measure ICD-10 accuracy\u2014per code and per record\u2014focus on assessing coding quality. Results can vary widely depending on the process.

template sample medical coding audit report

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What are three goals you would set before a coding audit?

There are many goals in an audit: Identify errors in provider documentation. Identify inefficiencies in payer reimbursement. Determine usage of incorrect medical codes, such as use of deleted or modified codes.

What are the 5 process steps to an audit?

Audit Process Working Together for the Best Result. You can expect to be involved or kept informed in every stage of the audit process. ... Planning and Risk Assessment. ... Fieldwork \u2013 Project Based Work. ... Reporting. ... Follow Up Monitoring.

What is a coding audit plan?

A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation.

What is the purpose of a coding audit?

A Coding Audit is an internal or external review of a medical office's coding practices conducted by reviewing patient medical records. Medical record audits target and evaluates procedural and diagnosis code selection as determined by physician documentation for completeness and accuracy.

What are the steps to conduct an audit?

Audit Process Step 1: Planning. The auditor will review prior audits in your area and professional literature. ... Step 2: Notification. ... Step 3: Opening Meeting. ... Step 4: Fieldwork. ... Step 5: Report Drafting. ... Step 6: Management Response. ... Step 7: Closing Meeting. ... Step 8: Final Audit Report Distribution.

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