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HEALTHCARE HAS UNDERGONE several major upheavals in the past five years. Many organizations adopted new electronic health record (EHR) technology while navigating the implementation of ICD-10-CM/PCS. In the years since the adoption of ICD-10, organizations have steadily navigated new systems and processes.
While ICD-10 coding productivity may not have fully rebounded to ICD-9 levels, it is steadily increasing. In February 2016, ICD-10 productivity was 22 percent below previous ICD-9 rates; as of July 2016, productivity had increased to 11 percent below ICD-9 rates.1 Now that productivity concerns have eased, organizations can resume ongoing coding audit programs to ensure optimal data and reimbursement.
Coding Audit Landscape Changing
In the years prior to ICD-10 implementation, many organizations focused on "hiring bodies" who had some knowledge of coding. ICD-10 was a new frontier and few, if any, coding professionals had experience with the system. As a result, health information management (HIM) departments were open to hiring staff with a lesser skill set and providing on-the-job training. Consequently, the primary focus of coding audits during that time was to ensure coder proficiency with the new coding system.
Now that coding professionals are more skilled and familiar with ICD-10, HIM leaders are evaluating internal processes to ensure high levels of coding quality and productivity. Coding audits are now focused on what is meaningful to the organization rather than conducted in reaction to outside influences.
More frequent coding audits are now more commonplace. Best practice involves ongoing, consistent audits focused on 3.5 to five percent of total volume per month. Auditors adhere to a schedule to review sample cases every week. As part of the HIM workflow, this routine promotes efficient mitigation of any repetitive coding...