Coding Quality: It Affects More than Claim Reimbursement
CODING VALIDATION AUDITS
iMetrix Health Solutions’ Coding Audit Services features a team of dedicated auditors who thoroughly understand the complexities behind coding accuracy in today’s healthcare environment. When considering coding quality, think beyond DRGs and APCs and recognize that coded data impacts reimbursement, patient safety indicators (PSIs) and healthcare acquired conditions (HACs). Our coding compliance and validation services assess the coding accuracy of your facility coders.
Coding reviews are offered on a pre-bill or post-bill basis and can be performed on-site or remotely. Our service identifies coding changes, additional conditions that should be coded, sequencing errors, modifier errors or omissions, present-on-admission accuracy, and disposition accuracy. Each of these may change reimbursement. When identified, cases resulting in a DRG or APC change are referred to the coding manager or coder for review and discussion with our reviewers. These insights are then translated into a customized educational plan to help address the root causes behind your coding issues.
WE IDENTIFY:
Education for medical staff to enhance documentation to assist coders
Inappropriate or inadequate querying practices
Cases with potential changes that will result in improved reimbursement while remaining in compliance with various regulatory agency requirements
Cases where the documentation does not support the codes claimed and may require refunding of payments to remain compliant with CMS and payer expectations