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What Is The Value Of ICD-10 Auditing?

Posted By Giovanna Stahl

In the field of healthcare, it may be challenging for your team to prevent inaccurate medical coding and billing procedures from falling through the cracks. While it’s understandable that this does happen due to miscoding or insufficient documentation, hospitals and healthcare organizations must do their best to maintain accurate code assignments, optimize reimbursements that accurately reflect quality services, minimize denials, and regulatory and compliance liabilities to ensure the accuracy of your patients’ records. 

 

At ECLAT Health Solutions, we have the experience to support your team, as they all play a vital part in helping your facility maintain coding accuracy. As your team works together to raise the standards of efficient coding practices, choosing our ICD-10 auditing services will help you significantly reduce inaccuracies, minimize or mitigate denials and appeals, and overall improve your organization’s healthcare processes. 

 

Our ICD-10 auditing specialists are focused on inpatient, outpatient, and pro-fee coding for ICD-10-PCS, CPT-4 and HCPCS code sets, which are used on a daily basis in healthcare organizations around the world. Our experts will pinpoint any harmful patterns and trends and provide effective solutions that will help your healthcare facility implement the most efficient practices for you and your existing teams. 

 

Here’s a brief coding recap before we dive into what you should know about the value of professional ICD-10 auditing services & how it will help you: 

The Basics of ICD-10-CM And ICD-10-PCS

ICD-10-CM (International Classification of Diseases - 10th Revision-Clinical Modification), is the diagnosis code set developed to classify and report diseases in all U.S. healthcare settings as well as record the actual problem that the patient is experiencing during an encounter. ICD-10-PCS (Procedure Classification System) is the procedure coding system used to describe the actual procedure(s) that took place when treating the patient’s diagnosis. Our auditing professionals at ECLAT Health Solutions are primarily focused on comprehensive auditing processes that have the ability to be customized in frequency or sample size, which includes ICD-10-CM, ICD-10-PCS, and the following code sets below. 

CPT 

Current Procedural Terminology, also known as CPT, is a specific medical code that is utilized to report on procedures as well as services – medical, surgical, and diagnostic – to providers and payers including health insurance companies, physicians, and officially accredited organizations. Some examples of the most commonly used CPT codes are new patient office visits, emergency visits, office consultations, and established patient visits or patients who have already been seen by a physician in that facility. CPT codes are mostly used in tandem with ICD-10-CM coding throughout the medical billing process. 

HCPCS 

The Healthcare Common Procedure Coding System, HCPCS, helps Medicare and health insurance providers organize and manage healthcare claims. Considering that the HCPCS Level I code set is collective of CPT codes, which was created and currently the property of the American Medical Association (AMA), HCPCS Level II codes are mostly used by healthcare professionals, and medical coding and billing specialists. HCPCS Level II Codes are applied to specify the medical supplies and goods, non-physician services provided, as well as the codes that don’t distinguish the Level I codes.  

Why Choose Professional ICD-10 Auditing Support Services?

When these code sets are not entered accurately, we can provide ongoing quality auditing support to help your medical coding team reduce inaccuracies and improve your facility’s return on investment.ROI. We can accommodate your preferred sample sizes for differing charts, types, and code sets that will be audited. This way, reimbursements will be properly optimized to emulate the quality of services being provided while lessening any regulatory and compliance liabilities.    

 

When you work with ECLAT, you may customize your auditing services with the following below: 

  • Inpatient medical records 
  • Outpatient ambulatory surgery medical records
  • Observation medical records
  • Emergency department medical records
  • Outpatient ancillary medical records
  • Physician professional services 
  • Clinical documentation improvement (CDI) opportunities

 

If requested, we also offer additional services that are highly focused on: 

  • Confirmation of principal diagnosis, first-listed, and principal procedure assignment.
  • Verification of all secondary MCC, CC, and other reportable diagnosis and/or principal procedure selection/assignment.
  • Validation of discharge disposition and transfer status.
  • Operational assessment related to coding.

 

Also, ECLAT will document discrepancies and ensure compliance, as requested, with the following:

  • Fraud and abuse issues per HIPAA and HITECH regulations.
  • Federal and State and other regulatory entities.
  • Research and detailed explanation of coding rationale related to appeals processes.

Additional Auditing Education Offerings

Not only do we provide on-going auditing support, but we even offer educational trainings to help your staff (CEO, CFO, Controller, HIM Director, Coding Manager & Supervisors, Coders, and Physicians) obtain the knowledge they need to improve your facility’s healthcare experience. Here’s a list of the training sessions we offer:  

  • Executive Summary outlining the entirety of the audit, initial findings, as well as results.
  • Final Report with findings, as well as your facility’s overall performance for MS-DRG/APC and coding accuracy
  • Financial impact analysis
  • Education session for coding staff
  • Training on specific coding/abstracting/query logic 
  • Debriefing session with desired hospital leadership team

Experience Quality ICD-10 Auditing Results With ECLAT Health Solutions

ECLAT Health Solutions can provide your healthcare facility with personalized ICD-10 auditing assistance that’s needed to provide valuable insight and lessen coding issues caused by inaccurate coding assignments. Our auditing experts will help you conduct regular coding audits that are accurate and align with compliance to create a much stronger foundation for the healthcare industry. 

 

Interested in speaking with a representative in person? Join ECLAT Health Solutions at the next AHIMA Convention & Exhibition 2019 September 15th - 17th, or fill out our form today for more information on our ICD-10 auditing services! 

 

Tags: ICD-10, ICD-10-CM, ICD-10 auditing, ICD-10-PCS