For small healthcare organizations, juggling any of the numerous responsibilities you already have to facilitate smooth operations is time-consuming enough. Whether it’s consistently providing quality care to all your patients or managing basic administrative tasks, your plate is generally full.

Even so, though, accurate medical coding audits are a vital aspect of any successful medical practice in California, regardless of the size.

Although coding accuracy can seem slightly technical with the full quality assurance process, the power it holds over your practice’s long-term financial health is undeniable.

Even one medical coding and billing error can start a ripple effect due to the upset to your short-term cash flow, leading to overall financial losses and possibly even legal complications.

Ultimately, to truly safeguard your practice’s revenue cycle management and prevent any gaping issues with your medical billing process, regular internal/external coding audits are essential.

So, throughout this article, we’ll be taking a look at some of the basics of coding audits, including which factors might influence their frequency and how you can be proactive. Let’s begin!

Understanding Coding Audits

Let’s start with a simple description of how internal coding audits actually work. Essentially, these aim to offer a fully comprehensive review of all the medical codes your practice is using whenever your medical coders are describing treatments or any services you’ve provided.

The main reason you’d opt for one of these is to evaluate how accurate and compliant your current coding practices are within your medical practice, mostly so you can find potential errors or inefficiencies but also for any non-compliance issues.

After the medical coding professionals have run the audit, the expected outcome is usually better patient care and practice efficiency (in terms of your claim submission process).

Benefits For Your Practice

In the wider scope of your practices’ financial longevity, the benefits of an external coding audit cannot be overstated.

Above all, one of the largest advantages is undoubtedly the potential for increased revenue. When your coding is both accurate and compliant, you generally stand a high chance of being properly reimbursed for the services rendered by your practice, allowing you to scale and develop with delay.

Furthermore, while these audits are mostly known for their ability to generate more revenue through improved compliance and reduced errors, they can also help uncover any missed opportunities for further reimbursements, like unreported procedures or under-coded services.

Factors Influencing the Frequency of Coding Audits

Still, it’s worth mentioning that while all practices would absolutely benefit from coding audits, not every practice needs to perform them to the same complexity and frequency as each other.

So, let’s take a look at a few of the main components you’d assess when working out how often you should conduct coding audits because there’s no one-size-fits-all amount of time, unfortunately.

Size and Complexity of the Practice

Generally speaking, larger practices tend to have a slightly higher risk of coding fraud and abuse, so in some cases, frequent audits can be essential in terms of maintaining compliance.

Smaller practices, on the other hand, sometimes won’t need to conduct audits quite as frequently because their coding processes are usually less intricate. That’s not to say they can overlook the need for regular audits altogether, though – even small practices can have issues with their coding process, and recovering from fines or suspensions can be even more difficult.

Frequency of Coding Changes

The frequency of coding changes within your speciality of care directly impacts how regularly you should be conducting coding audits.

As a general rule of thumb, practices with more frequent changes in coding guidelines should consider more audits so their coding practices stay aligned with the latest regulations.

Past Audit Findings

If your practice has a history of frequent coding errors or if previous audits have uncovered significant issues, it might be wise to conduct audits a bit more regularly.

This ultimately allows you to closely monitor and address any recurring problems, ensuring that corrective actions have been effective.

Auditing with Medical Coding Professionals

When it comes to conducting a thorough audit, not every practice can find the time out of their busy schedule to give it the due diligence it deserves – especially for smaller practices with fewer staff/resources.

By outsourcing to PMN, you’ll be able to receive comprehensive audits and physician services that are tailored to your needs.

PMN have over 20+ years of keeping up with the ever-changing industry guidelines and regulations, so you can be confident that your practice remains fully compliant at all times for maximum reimbursement.

If your practice operates within California and you’d like to learn more about PMN’s medical coding audit services, get in touch with their team today at (949) 215-5055. If you’d prefer to discuss any clinical documentation/medical record documentation in person instead, visit their office in Laguna Hills, Orange County, California!

FAQs

How Do Coding Errors Impact Healthcare Practices?

Firstly, they often lead to claim denials which cause delayed or lost revenue. Naturally, this can negatively affect your practice’s financial health and sustainability. Moreover, coding errors can result in incorrect documentation of medical conditions and procedures, potentially compromising patient safety and the quality of care delivered.

Are Coding Audits Only Necessary For High-Volume Practices?

Coding audits are valuable for practices of all sizes, including smaller ones. While high-volume practices may have a greater volume of claims to review, smaller practices can certainly still benefit from coding audits. Without them, you run a much higher risk of inaccurate coding and missed revenue opportunities, preventing you from growing in the long term.