martnel
Guest
What would be a good percentage of accuracy in an audit for surgery coding?
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Wiki Accuracy in coding?
- Thread starter martnel
- Start date
Accuracy
When we audit providers, we recommend 90% accuracy. However, I always stress that if the provider's record were to be audited by a payer, they would likely not pay the claim if the record is inaccurate. Also, if the OIG were to audit a sample and find more than a 5% error rate (so 95% accuracy) they would likely investigate further. Its a good practice to have this in a compliance plan of what the acceptable accuracy rate for the practice is. Some practices are very lenient and allow 80%. I do not recommend anything lower than that.
When we audit providers, we recommend 90% accuracy. However, I always stress that if the provider's record were to be audited by a payer, they would likely not pay the claim if the record is inaccurate. Also, if the OIG were to audit a sample and find more than a 5% error rate (so 95% accuracy) they would likely investigate further. Its a good practice to have this in a compliance plan of what the acceptable accuracy rate for the practice is. Some practices are very lenient and allow 80%. I do not recommend anything lower than that.
MnTwins29
True Blue
We use 90% as the threshold for coding done by providers as well. For coding done by certified coders, whether professional and/or facility and whether at our hospitals or clinics, we use 95%. I know that threshold has been recommended by AHIMA, but I have to search to find that documentation.