Outpatient 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.
Furthermore, the need for outpatient auditing has become increasingly important due to the increase in overseas medical coding, which has a higher error rate than domestic coding.
Along with inpatient and physician auditing and compliance services, 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.
Why Is Outpatient Auditing & Compliance So Important?
Outpatient auditing and compliance play a crucial role in the field of medical billing, ensuring the accuracy, integrity, and legality of healthcare financial transactions. Due to the complex nature of healthcare billing and the potential for errors or fraudulent activities, auditing and compliance measures are essential to maintain the integrity of the billing process.
One of the primary reasons outpatient auditing is vital is to ensure accurate reimbursement for healthcare services. Billing errors can lead to underpayment or overpayment, affecting the financial health of healthcare providers. By conducting regular audits, CBS clients can identify and rectify coding discrepancies, documentation issues, or other billing errors that may lead to financial losses.
Compliance in outpatient services is equally important to adhere to regulatory standards and guidelines set forth by governmental bodies such as the Centers for Medicare & Medicaid Services (CMS), private payers, the ICD (International Classification of Diseases) coding regime and the CPT (Current Procedural Terminology) system.
Furthermore, compliance with HIPPA (the Health Insurance Portability & Accountability) is essential to protect patient privacy and ensure the secure handling of health information. Non-compliance can result in severe penalties, fines, and legal consequences. CBS is always up to date on the latest regulations and implementing compliant billing practices is essential for healthcare organizations to avoid legal ramifications and maintain their reputation in the industry.
Moreover, outpatient auditing helps prevent and detect fraudulent activities, which can be detrimental to both healthcare providers and patients. CBS outpatient audits reveal irregularities in billing patterns or coding practices can help organizations mitigate fraud risks, protect patient data, and ensure that resources are allocated appropriately.
The CBS Auditing Process
When performing an outpatient 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 skill level in ICD-10-CM and CPT.
- Analyze your claims data to target specific areas for focused audits.
- Determine the appropriateness of your team’s ICD-10-CM diagnosis.
- Evaluate your HCPCS/CPT procedure code selection, facility evaluation and management (E&M).
- Determine the completeness of documentation to support appropriate coding assignment.
- Validate physician orders, NCDs and LCDs in terms of the medical necessity of services.
- Ensure that the correct code transfer to the claim forms has occurred and that the correct APC payment has been received on the remittance information.
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 outpatient auditing and compliance, you can be assured that your organization will be in compliance with all best practices and standards.
Ongoing Monitoring & Improvement:
Regular audits and monitoring processes help identify areas for improvement. Continuous feedback and education contribute to the ongoing enhancement of outpatient 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 outpatient medical coding process, contact us today.
Please call us at 610-428-9034 or fill out our Contact Form.