Inpatient Auditing & Compliance
Inpatient auditing and compliance review of medical coding are essential components of healthcare management that ensure accurate coding of medical services, adherence to regulatory guidelines, and overall compliance with established standards.
Coding & Billing Solutions specializes in this critical auditing function and can help your organization avoid the financial penalties, loss of reimbursement, legal issues, and reputational damage that can result from inaccurate coding.
The types of inpatient auditing the team at Coding & Billing Solutions provides include:
- Comprehensive Coding Quality Reviews
- APR-DRG reviews
- MS-DRG reviews
- Top 5 MS-DRG Reviews
- Query Reviews
Why Is Inpatient Auditing & Compliance So Important?
Accurate coding at hospitals, Physicians’ offices and other health care entities is crucial for various reasons, including billing, reimbursement, and statistical analysis. It also helps in communication between healthcare providers, insurance companies, and government agencies.
In terms of regulatory guidelines, inpatient coding must adhere to various regulatory guidelines, including the International Classification of Diseases (ICD) coding system and the Current Procedural Terminology (CPT) system.
Furthermore, compliance with the Health Insurance Portability and Accountability Act (HIPAA) is essential to protect patient privacy and ensure the secure handling of health information.
The CBS Auditing Process
When performing an inpatient audit, the expert consultants at CBS will engage in a detailed and comprehensive review. The following are our client audit process steps:
- Review your team’s expertise in MS-DRG, APR-DRG, and ICD-10-CM/PCS
- Evaluate the completeness of documentation to support accurate code assignment.
- Determine the appropriateness and applicability of physician queries.
- Validate physician admission orders.
- Verify that the proper discharge disposition is in place.
- Ensure the correct code transfer to the claim forms and the correct MS-DRG payment is received on remittance advice.
CBS Helps You Avoid The Consequences of Non-Compliance
Inaccurate coding or failure to comply with regulations can lead to financial penalties, loss of reimbursement, legal issues, and damage to the reputation of the healthcare facility. When you work with CBS on your inpatient auditing and compliance, you can be assured that your organization will be in compliance with all best practices and standards.
Ongoing Monitoring and Improvement:
Regular audits and monitoring processes help identify areas for improvement. Continuous feedback and education contribute to the ongoing enhancement of coding accuracy and compliance. CBS can be your ongoing partner in making sure your organization is always compliant by conducting regular audits and providing employee education.
If your organization could benefit from an expert, 3rd party audit of your inpatient medical coding process, contact us today.
Please call us at 610-428-9034 or fill out our Contact Form.