Internal Coding Audit Program: Reduce Your Compliance Risks

Do you know which clinical coding practices put you at a high risk for scrutiny by the Office of the Inspector General (OIG)? Gloryanne Bryant knows. During this ICD10monitor webcast, she’ll share her findings, using case examples to illustrate, and then explain how to apply this knowledge to the design and implementation of a successful internal coding audit program.

The value of an internal coding audit program cannot be overstated. Done right, it’s a valuable ally for addressing your areas of vulnerability — reducing your compliance risks and ensuring that you’re receiving the full appropriate reimbursement. Possessing four decades of coding expertise, Gloryanne will spell out the essential building blocks of an audit program: understanding your coding and documentation risks; creating a formal program framework and processes; gauging current coding accuracy rates; and developing a corrective action plan that includes Medicare-compliant rebilling.

Why This is Relevant:

Coding, of course, serves as the foundation for reimbursement by Medicare and other payers. Inaccurate coding not only compromises your revenue stream, but it increases the likelihood of adverse action by auditors. An effective internal coding audit program safeguards your organization’s financial integrity, while providing strong protections for your compliance.

Learning Objectives:

• Identify key elements and best practices for an internal coding audit program, including scope, process, findings and corrective action with rebilling
• Know how to identify documentation and coding errors, as well as other areas where improvement is needed
• Understand common risk areas, including those cited by the OIG, to audit for inpatient and outpatient encounters
• Get a firm grasp on coding audit scenarios involving complications or comorbidities (CCs), major CCs (MCCs) and hierarchical condition categories (HCCs), along with the necessary auditing resources

Who Should Attend:

HIM director; coding staff (inpatient and outpatient); coding director, manager and supervisor; physician office coding staff and management; data quality/analytics staff; coding auditors; coding educators and instructors; revenue cycle director and manager; rehab coding leadership; and skilled nursing facility coding management.