The Essential Guide to Coding Audits

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The Essential Guide to Coding Audits

Product Code: EGCA

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The Essential Guide to Coding Audits

Learn how to adjust—and measure success—while running an effective audit in today’s fast-paced, resource-limited environment

The complexity of ICD-10 creates challenges not just in code selection but coder productivity, quality of work, and training as well. At the same time, this has increased the need for effective auditing processes. Learning the ins and outs of auditing and refining your internal coding audit process is the first step in avoiding denials.

The Essential Guide to Coding Audits takes an in-depth look at the coding auditing process, ranging from external audits and accuracy rates to structuring your own internal coding audit program. This book can be your constant companion and reference throughout the audit-refining process, and is a must have for coding managers and coders looking to avoid denials and produce the most accurate claims possible.

Readers will learn to: 

  • Structure an internal coding audit program 
  • Describe various types of payer audits 
  • Explain the ins and outs of payer guidelines 
  • Recognize methodologies used from the point of view of reviewers 
  • Differentiate types of coding audits (internal and external) 
  • Calculate accuracy rates 
  • Provide audit feedback 

About the Authors:

Rose T. Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS, is a past president of the American Health Information Management Association (AHIMA) and recipient of AHIMA’s 1997 Distinguished Member Award. She is chief operating officer of First Class Solutions, Inc., of St. Louis. Her consulting firm, First Class Solutions, focuses primarily on HIM-related services, including coding support, coding audits, and operations improvement. Dunn also serves as an expert witness for release of information lawsuits (ROI) and advisor to organizations on ROI issues. Dunn is active in several professional associations, including the American Institute of Certified Public Accountants, American College of Healthcare Executives (ACHE), Healthcare Finance Management Association (HFMA), and AHIMA. She also holds fellowship status in ACHE, AHIMA, and HFMA and is certified in healthcare privacy and security.

Contributor: William L. Malm, ND, RN, CRCR, CMAS, is a managing director at Health Revenue Integrity Services. He is a nationally recognized author and speaker on topics such as healthcare compliance, chargemasters, and CMS recovery audits. Malm brings over 25 years of experience with a combination of clinical and financial healthcare knowledge that encompasses all aspects of revenue integrity. He also serves as the secretary/treasurer for the Certification Council of Medical Auditors. He has extensive experience with all postpayment audits, having previously worked as a systems compliance officer at a large for-profit healthcare system. Malm also co-hosts Appeal Academy’s “Finally Friday” discussions. 

Published: April 2018

Page Count: 164 
Dimensions: 7” x 9” 
ISBN: 978-1-68308-710-6 

Table of Contents

Chapter 1: Introduction to Coding Audits
Chapter 2: Conducting Coding Audits
Chapter 3: Types of Coding Audits
Chapter 4: Developing a Coding Compliance Plan
Chapter 5: Audit Focus and the Approach of Insurers
Chapter 6: Implementing a Coding Compliance Plan
Chapter 7: The Coding Auditor’s Role in Denial Management
Chapter 8: Communicating Results to Providers and Coders