How to Protect Yourself in a Medical Coding Audit - dummies

How to Protect Yourself in a Medical Coding Audit

For a medical coder, protection from an audit comes only one way. If the documentation is clear, an audit is no problem. In fact, documentation is the only way to protect yourself in an audit. Follow this advice:

  • Make sure you understand the documentation needed to code and bill procedures.

  • Make sure that you understand the payer contracts and submit claims within the confines of that contract.

  • Be especially careful with unbundling. Codes are bundled for a reason: because they should be included with the primary procedure that was performed. Sometimes, procedures are extra, usually for anatomical reasons. Then, coding both procedures separately may be okay, but make certain that the documentation supports both procedures.

  • Make sure that you code only what the documentation supports and that everything you do as a coder is part of the record. The phrase “That is what the doctor meant” can be a problem for obvious reasons.

  • If a provider insists that, when he says “A,” he means “B,” then get it in writing. The same holds true for unbundling procedures. If the provider insists that certain procedures be submitted “because he wants to track them” or because “XYZ will pay it,” get it in writing.

If you follow these guidelines, you can stop sweating and start getting your ducks in a row so you’re prepared if and when the time comes to have your work audited. That way, you have no worries.