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Getting a full return on an external audit requires that HIM directors commit to the process from start to finish - preparing, managing, and following up.
IS YOUR CODING GOOD, BAD, OR GREAT? Not knowing for certain creates risk and stress. Audits offer visibility into departmental operations and coding processes. Consequently the term "audit," which generally brings forth feelings of fear and dread, can also deliver security and peace of mind. This is especially true in clinical coding.
In fact, coding audits have become so valuable that providers are advised to conduct external audits at least once a year.1 External audits can objectively analyze operations, detect holes in the system, and uncover deficiencies that an internal audit program may miss. This outside review helps strengthen future internal audits by discovering how and why internal audits may have overlooked findings.2
However, external audits require significant time, effort, and money. HIM can make the most of them and achieve a clear return on investment by following through in three key steps: preparing for the audit, managing the audit, and implementing the recommendations.
1. Preparing for the Audit
The first step in preparing for an external coding audit is identifying clear, concise goals. These goals should be specific to the organization and designed to address current needs. Once audit goals are clearly defined and documented, HIM directors can secure executive support, prepare coders, and identify cases.
Set Clear Goals
Clear goals will help ensure audit feedback is on target with the organization s objectives. Setting goals will give HIM directors meaningful recommendations instead of binders full of unnecessary reports. Some HIM directors will have a specific goal or organizational challenge that drives the audit. Others may have predefined areas for the audit based on internal quarterly review findings, staffing changes, or upcoming initiatives such as RAC.
Amy Phillips, RHIA, is the HIM director at All Children's Hospital in St. Petersburg, FL. She was new to her position when she decided to contract with an outside agency to conduct a coding audit. She had a clear goal - to obtain a solid baseline of coding quality.
Phillips needed an auditing partner with pediatric coding experience and a thorough understanding of present on admission (POA) coding for pediatrics (a...