Incompatibility Reaction: 7 Tips for Highly Effective Audits
Nobody likes to have their work subject to oversight, grading, and criticism. But most people do like to get educated, improve their skills and make themselves more valuable to their organization. When positioned as a learning experience, coding audits can be extremely beneficial for everyone involved, including physicians.
Whether your audits are internally-conducted or led by an outside, industry consultant, “how” you present findings is critical. Presenting audit results as an educational benefit tends to yield the best results. Here are seven steps for highly effective and collaborative audits.
- Communicate early in the process with both coders and physicians. Everyone should be aware of the internal and external “eyes” upon them.
- Remind everyone involved that no one is perfect and even the best coders / physicians can do their jobs better.
- Work at the individual level when presenting case or employee-specific findings and recommendations. This is where one to one communication is best.
- Include findings and new learning objectives as a performance goal in employee evaluations.
- Garner executive level support for your coding compliance program, particularly as it relates to improving physician documentation. Getting the Chief Medical Officer on board is crucial!
- Be professional, non-threatening and take the time to listen. Present the facts – not opinions. And remember that listening is the most important part of effective communication.
- Finally, establish an appeal process should coders or physicians disagree with auditor findings. Allow room for discussion and negotiation.
Yes, physicians, coders and auditors can be compatible…even when they sometimes disagree! Share your top tips for audit success here and thank you for reading.
When does a coder find time to remain current with coding/billing/carrier rules, regulations, and guidelines? It is a constant struggle and many employers do not offer financial assistance with this requirement. So, when an employer does conduct a coding audit, whether internal or external, this is an opportunity for a medical coder to acquire and absorb new knowledge, improve performance, and correct any misunderstood concepts. Coders, take advantage of the audit!. It is a tool for your organization to measure it’s efficiency but also is part of a coder’s continuing education. Use it to your advantage and benefit from the outcome!
I agree with the concepts and the guidance outlined in the article written by Deborah Robb. From a managerial perspective, I feel it is always appropriate to publish the minimum expected accuracy rates so that both the coders and physician office billing staff and physician’s understand what the expectation is, and how that might reflect on personal performance assessments. I also agree that audits are most useful as an educational tool that can readily identify personal, departmental, or facility wide educational opportunities. The goal for any manager should be to raise their people up and help them reach and exceed the minimum expected accuracy levels; and only if additional education does not improve performance, should any results result in disciplinary actions.
Regarding Donna’s concern regarding education, she is absolutely correct when she says that there are very little education dollars out there for continuing education. As hospitals and other healthcare providers have been challanged with meeting fiscal goals, or even staying alive in the current climate, fiscal responsiblitity at every level has to be considered.
In saying that, there is a great deal of free coding education out there that might be worth taking a look at. CMS and NGS (the fiscal intermediary for VA), have a wealth of information on there. There is also apportunity to join the Listserves for CMS and other regulatory bodies, that will send selected information to your email if you request it.
I also agree with Deborah’s 7 tips. Auditing is a difficult task whether you are the auditor or the one being audited (I have been on both sides). I think the most important things are to know your facts, be professional, compassionate, open-minded, and be able to accept corrective criticism. I have worked at several different facilities, some where I was audited quarterly and some where I was never audited and I think being audited keeps you on your toes! I would much rather know if I needed to sharpen my skills than to no nothing at all! Great tips!
My management style promotes staff the ability to contribute their ideas to develop positive outcomes when developing new processes or modifying old ones. In addition, to the normal reasoning for auditing to validate compliance and accuracy I have found that auditing provides an essential tool to develop excellent communication between co-workers and management.
I don’t mind being audited it and if I make mistakes then I will try not to make the same mistakes again. Also, it only proves that I am not perfect and I am not always right.