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Why is the Medical Coding Audit Function More Important Than Ever?

Medical Coding Audits More Important Than Ever

It’s all about Clinical Documentation Improvement (CDI).

With the recent implementation of ICD-10, Nearterm believes that coding audit practices are now a critical part of what healthcare organizations must do to remain compliant and sustain healthy cash flow.

Briefly, medical coding audits seek findings that support CDI implementation and ongoing CDI practices.  The audit process also reveals root causes of coding errors that can increase denials and put pressure on revenues. And there is more.

What Comprises Medical Coding Audit and How Does It Translate To Both Short Term and Long Term Benefit?

 Nearterm Medical Coding Auditors and CDI experts can provide the following range of services (and more) based on client needs:

  • Performs concurrent ICD-10 coding analysis of medical records and provider claims to validate code assignment
  • Reviews physician and provider documentation for high quality clinical documentation, based using evidence-based clinical criteria that translates into and supports accurate diagnostic and procedural coding
  • Applies official guidelines for coding and reporting consistently and appropriately
  • Provides written explanations to support or rebut coding recommendations
  • Develops and presents educational material for coding professionals
  • Serves as a coding resource for Health Information Management (HIM), Quality Assurance, Utilization Review, and Patient Accounting Department
  • Provides support for training new and experienced coding staff
  • Supports developing and presenting clinical documentation improvement program education for physicians

What does it take to be a Nearterm Medical Coding Auditor?

Nearterm has high standards. That said, our experienced Medical Coding Auditors and CDI experts typically have the following background and skills:

  • RHIA, RHIT, or CCS credentials
  • 5 or more years of medical coding experience
  • ICD-10 training
  • Excellent knowledge of Official Guidelines for Coding and Reporting as well as AHA Coding Clinics to support audit findings
  • Outstanding computer skills
  • Excellent written communication skills
  • Ability to efficiently review large volumes of documents with high comprehension level
  • Secure home office environment, compliant with HIPAA requirements if working remotely

As an HIM Managed Services Provider, Nearterm can provide clients with Medical Coding Audit and CDI services as part of a 360 Managed RCM Services solution.

As a “Managed Service Provider,” our staff are professionally managed and their performance is measured by a Nearterm Partner in Charge (PIC). This is to ensure they meet the service level quality requirements agreed upon with the client, as expressed in our Q100=Quality Assurance program.

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