Value of Internal Audit Reviews

What Value Can an Audit and Review Provide?

Over-Coded vs. Under-Documented

Over-coded has become a buzzworthy term in compliance, but one that our team uses with caution due to the implications it bears. What is noteworthy is that typically the medical necessity of the service, under review, supports the level of service, however, the audited complexity is under-documented. The DM team works with providers on ways to efficiently and effectively communicate this through the documentation of each service.

Under-Billing

Many providers are unsure of what level to choose, and therefore they reason it may be better to level down in their code selection. There is no need to teach providers how to choose a 2,3,4 and 5. Using their own coding patterns, the national trends per specialty, and their audit review findings, we can teach them how to choose their codes more specifically. Providers are not tasked with under or over-coding- but rather with CORRECT coding.

Services Under-Utilized

If an audit sample is comprehensive in nature, it will sample all service lines of a provider. While evaluating these service lines it opens the door for consideration of services that may have been underutilized as well.

Identify Compliance Concerns

It is our hope that an audit review finds zero compliance risk for your organization, but at the end of the day, the goal of an audit is absolutely to find risk. So, be comfortable knowing that is our job going into the project. Help your providers know that also. Our team works hard to not only point out deficiencies but also the proficiencies of your providers and your organization, but at the end of the day, it is a mock carrier audit.

How to Become a Medical Auditor

Certified Medical Auditors (CPMAs) utilize their knowledge of learning medical terminology, medical coding, and documentation guidelines to improve the revenue cycle of medical practices. A medical auditing career includes working with medical records technology and health services administration, applying your medical coding skills in a new realm.

Associations such as NAMAS, AAPC or American Health Information Management Association (AHIMA) will give guidance on training for and certification exams, accreditation, and medical coding certificate if you would like to become a biller or coder.

A medical auditor career track can lead you to a rewarding position in offices charged with managing medical documentation, medical procedure documentation or medical services.  Types of courses include but are not limited to: certified coding associate, certified coding specialist, level ii coder, national certifications, CPT coding, procedure coding, certified professional coder certification (CPC), medical records review, icd-10 coding, CCS, or CCP designations, and the focus can be on inpatient or outpatient services.

Medical Coding Auditor Certificate & Exam Prep Course will help you pass the national board exam on the first try so you can become a professional medical auditor. Here’s what you’ll learn about in the course:

• Medical Records
• Coding Concepts
• Reimbursement Methods
• Quality Assurance
• Risk Analysis
• Scope Sampling
• Modifiers