Coding Audits and Denial Management
New research claims the typical health system risks $4.9 million each year due to claims denials.
Preventative action is critical and audits are a practical approach. Whether to validate code assignment, check DRG selection or review coding compliance, H.I.M. ON CALL’s expert auditors deliver an unbiased view of quality and accuracy. Each audit is tailored to meet the client’s specific needs and expectations.
Learn how our credentialed auditors pinpoint your areas of revenue vulnerability and identify opportunities for financial and coding performance improvement.
After the Audit: Focus on ICD-10 Specificity and Financial Impact
ICD-10 elevated the need for specific code assignment so the use of unspecified codes will likely result in claims denials and recovery contractor reviews. Our expert team takes a closer look at any unspecified diagnosis or procedure codes to:
Define unspecified code rate
Uncover possible causes and opportunities for improvement
Report missed query opportunities
Determine financial impact
Recommend targeted education for coders, CDI specialists and physicians
Audit Program Checklist
Here is specific data that our auditors identify and use to summarize clients’ findings:
| Client Deliverable | Inpatient Audit | Outpatient Audit |
|---|---|---|
| HOC Reviewer ID | X | X |
| Coder ID | X | X |
| Number of records reviewed | X | X |
| Number of changes | X | X |
| DRG Changes | X | |
| APC Changes | X | |
| APC accuracy rate | X | |
| E&M Level changes | X | |
| Modifier changes | X | |
| Patient Status changes | X | |
| Severity of illness changes | X | |
| DRG accuracy rate | X | |
| Principal diagnosis accuracy rate | X | |
| Overall coding accuracy rate | X | X |
| CC/MCC accuracy rate | X | |
| Financial impact | X | X |
| Reason for change | X | X |
| Summary of errors by ICD-10 CM chapter | X | |
| Summary of errors by ICD-10 PCS chapter | X | |
| Summary of errors by CPT section | X | |
| Rationale for changes with specific coding guideline references | X | X |