The Best Online Resources for Medical Auditors

Whether you need help making informed decisions for your organization regarding the RAC audits, or need a refresher on ethical e/m coding, this list of super useful audit resources has it all. I use many of these resources on a daily basis. They make my job that much easier and more enjoyable. And I think you'll find them just as useful as I do.

ICD-10 Monitor: ICD10monitor, is a division of Panacea Healthcare Solutions, Inc., and a great online news and information source created to “help healthcare providers make informed decisions as they implement the new ICD-10 coding system.”

The ICD-10 system is a process mandated by Congress under the auspices of the U.S. Department of Health and Human Services (HHS) and administered by the Centers for Medicare & Medicaid Services (CMS). While it’s not related to any government source, it is a very reliable website for healthcare providers and auditors. - http://www.icd10monitor.com

RAC Monitor: RACmonitor.com is a fantastic online news and information site that exists to “help healthcare providers make informed decisions for their organizations on the activities of Recovery Audit Contractors.” RAC is the congressionally mandated program under the Department of Health and Human Services (HHS) and administered by the Centers for Medicare and Medicaid Services (CMS). RACmonitor.com is a great resource for healthcare professionals. - http://www.racmonitor.com

CMS Website: The Centers for Medicare & Medicaid Services, CMS, is a government site and a part of the Department of Health and Human Services (HHS). They administer many programs, including: Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace. Some of the most useful pages on the CMS site for auditors include the following:

• Medicare OPPS info at CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html
• Medicare Physician MPFS and RVU data at CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html
• National Correct Coding Initiative (NCCI) Edit data at CMS website: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
• Medicare Outpatient Code Editor (OCE) data at CMS website: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/index.html
• Medicare Clinical Laboratory Fee Schedule (CLFS) at CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/index.html
• Medicare Physician Quality Reporting System (PQRS): https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
• Medicare Transmittals: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/index.html
• Medicare Online Manuals: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/index.html
• Medicare National and Local Coverage Decisions: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx

E/M University: Peter R. Jensen, MD, CPC is a practicing physician and a certified professional coder. He currently practices in Connecticut and is Director of E/M Compliance for the Yale-New Haven Hospitalist Service. He is a renowned national speaker who frequently covers accurate and ethical E/M coding and documentation from a physician’s point of view. Every auditor should be familiar with his site because he posts some really great content. - http://www.emuniversity.com

YouTube: Videos are a great way to learn and I love Youtube for video examples of surgical procedures (example: Intraocular Lens surgery). - https://www.youtube.com/watch?v=3ridZ7LVTbE

I also follow a lot of Specialty Society websites specific to an audit I’m performing. For example, Radiology: The American College of Radiology, was founded in 1924, and is a professional medical society “dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.” If you’re auditing radiology, their website will be incredibly useful. - http://www.acr.org

I’m sure I’m missing a lot of great resources. What are some websites that you’d recommend to your fellow auditors?