How Often Should My Office Be Conducting Medical Coding Audits?

by  Find-A-Code™
Dec 14th, 2023

Medical coding and billing are all about getting paid when you boil the two practices down to their simplest forms. And yet, there are other things to think about. Compliance is one of them. That is why hospitals, clinics, and private practices conduct medical coding audits. A big question for smaller offices is how frequently audits should be conducted.

At minimum, the U.S. Department of Health and Human Services recommends annual compliance audits. But again, that's the minimum. Nothing prevents an organization from auditing its medical coding and billing practices more frequently. There are justifications for doing so.

Why Audits Are Necessary

Medical coding audits are a necessary component of providing high quality care, maintaining compliance, and developing strong and lasting relationships with payers. Generally speaking, regular audits ensure:

• more accurate clinical documentation
• a more consistent revenue cycle
• improved revenue cycle management
• ongoing compliance with all regulations

Auditing a practice's medical coding and billing is no different than auditing its finances. Audits work to help uncover deficiencies so that they can be corrected. Audits also reveal what seems to be working well. This is just as helpful as organizations can take what works and build on it.

Circumstances Dictate Frequency

Getting back to the central question of how often medical coding audits should take place, there is no schedule that could be applied to every organization in the healthcare industry. More often than not, circumstances dictate audit frequency.

More frequent audits increase the chances of detecting and correcting deficiencies early on. The earlier, the better. More frequent audits also lead to improved accuracy in documentation, a proactive outlook on compliance, better training and education for coders and billers, and more consistent payments. Regular audits can even contribute to an organization's bottom line.

Four Things to Consider

Given that circumstances dictate how frequently an organization should conduct medical coding audits, you might be wondering what types of circumstances you should be looking at. Here are just four to get you started:

1. Organizational Risk – High-risk specialties have an equally high risk of medical coding and billing mistakes. Such specialties include things like oncology, interventional radiology, and even cardiology. The higher a biller's risk, the more frequently audits should be conducted.
2. Organizational Compliance – Every organization within healthcare should have a compliance plan in place. In order to meet the requirements of said plan, more frequent audits may be necessary. And when a plan is revised, the audit schedule should be revised as well.
3. Guidelines and Updates – As coding sets are updated and practice guidelines are modified, the risk of coding and billing errors goes up. Throwing in an extra audit or two while the team gets used to the updates could make a significant difference for the better.
4. Coding History – More frequent medical coding audits are likely in order if your organization has a history of excess errors. Every organization will experience minor errors from time to time, but excess errors indicate something is wrong. An audit should reveal what is going on.

Regardless of circumstances that could dictate more frequent audits, conducting at least one audit annually is non-negotiable. Every organization involved in medical coding and billing needs to make sure that its operations are up to par, or they risk revenue loss and potential legal problems. Neither represents a risk worth taking.

Should your organization be conducting medical coding audits more frequently? That is up to you and your executive team. But know this: you can never have too many audits. Consistently making sure that things are being done properly is the best way to go.