In 2020, the Covid-19 pandemic brought on multiple ICD 10-CM, AMA, and payer coding guideline changes. We had the new AMA and CMS guidelines for the 2021 Evaluation and Management Office Visit codes. Then there was the delayed release of the Medicare Physician Fee Schedule Final rule (followed by the new Stimulus Bill, which overturned some of the new codes outlined in the final rule). And to top it all off, the Department of Justice charged over 300 individuals for involvement in healthcare fraud, waste, and abuse schemes resulting in over $6 billion false and fraudulent claims – the most significant enforcement action in the department’s history.
Coding accuracy is more crucial than ever. And that’s why conducting audits on your coders is integral to ensuring quality and regulatory compliance for hospitals and medical practices. Why? Because external audits offer objective visibility into departmental operations, identify gaps in your coding processes, and uncover deficiencies and coding errors that an internal audit program may miss. Additionally, industry best practices suggest that outside reviews will strengthen your future internal audits. The choice is clear, and these two tips will help you get the most out of your audits.
But I get it; having an external audit can create a lot of anxiety. Nobody likes to feel like someone is scrutinizing their work. And that’s why a growth mindset is so important.
External Audit Tip 1: A Growth Mindset: The Art of Turning Everything into an Opportunity to Learn
Getting everyone in the right mindset is a crucial step for a super successful external audit. First, coders and auditors must let go of any perfectionist ideas and accept that nobody knows everything. Second, everyone needs to come to the table with a growth mindset. A growth mindset is about looking at every opportunity as a way to build yourself up, increase resilience, and learn. If everyone shows up ready to grow, it can make the experience enjoyable. Third, coders need to feel heard. Coding is an art as much as anything, and there are myriad reasons for a code choice. Give coders a seat at the table during the discussion of the results to defend their choices. After all, everyone should be there to learn, including the external auditors.
External Audit Tip 2: Audit Big, Audit Often
The Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) recommends that all physicians and non-physician providers review their coding by an outside independent party who has the appropriate expertise in that clinical specialty. The purpose of these reviews is to obtain an unbiased evaluation to ensure coding accuracy. So why wouldn’t coders fall into this same recommendation? The question isn’t why audit your coders. But instead, how many dates of service to review and how often. Go big, and then go home (and sleep soundly knowing that coding accuracy will improve and revenue will be safe).
There you have it, folks. For more details on why to hire external auditors and how to have a successful external audit, download my free eBrief, "Who’s Auditing Your Coders?"
Feel free to share additional tips and tricks in the comments below. We love to hear them.