• AHAP Inc.

How to Ensure Accurate Medical Coding Practices

With ever changing reimbursement models FQHC, hospitals and medical practices cannot afford the penalties and potential risks associated with inappropriate medical coding. Here are some strategies and recommendation.

Invest in Education

Medical coding is only as accurate as the knowledge acquired by your coding team. Ongoing education and training are essential for your coding staff because codes are constantly updated, added, deleted, bundled, and unbundled annually. Your coding team needs to stay on top of the latest changes otherwise the potential for a coding error increase.

Use Detailed Documentation

Detailed documentation is the core communication method for your physicians as it relates to patient care. Detailed documentation leads to accurate coding and appropriate reimbursement for your organization. It can help your coding team corroborate medical codes and provide evidence that care was provided. Inadequate or incorrect documentation results in delayed payments and can raise compliance issues. When revisions to codes occur, providing printed materials can help ensure your physicians know what they need to provide relative to accuracy with documentation.

Perform Regular Audits

To ensure better coding accuracy, schedule regular audits to discover if you have any coding issues. This is especially important if changes have occurred to the codes or you have staff turnover. In many facilities or physician offices, coding is often spread across a large, diverse group of personnel. This can sometimes lead to inconsistencies. Regularly-scheduled audits can identify areas where additional training or support may be necessary.

Provide Up-to-Date Coding Resources

Organizations should have the most current references related to medical codes at their fingertips. It should be accessible online as well in print. Archive the older annual published references in case a coding issue arises from a previously coded chart. In addition, CMS issues quarterly updates on modified codes so be sure to subscribe to these updates so you always have the latest medical codes.

As a busy healthcare executive, we understand keeping up with annual medical coding changes can be overwhelming at times and may even be costly as it relates to training and education. But it is necessary to ensure that you can provide accurate coding at all times. If you are too busy to manage your coding efforts or do not have the financial means to be on top of the latest changes, consider adding outside audit services and outsourcing your coding practices to a coding expert.

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