demorrison
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I am having a hard time deciding how to "audit" or check our EMR coder. How are others doing this? A percentage of charts, every visit, before or after billing? Any input would be greatly appreciated!
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Wiki Auditing EMR Coder
- Thread starter demorrison
- Start date
Pam Warren
True Blue
Are you auditing the coder, or the EMR coding function?
We typically audit at 100% pre-bill for all new providers using our EMR coding function, to identify issues with documentation, template training, or diagnosis code selection problems. Once they've reached 90% accuracy consistently, we only do periodic audits to make sure they're maintaining the standard. During this process, however, our auditors\educators engage the providers in focused training, so that in the long run, we don't have to have a coder look at every single claim. We're comfortable with 90% accuracy, which sometimes you don't even get with soft-coded claims!
If you're auditing a new coder who isn't an auditor (CMPA), then I'd take a sample of their work pre-bill. (25 charts of a variety of services, over a 2-week period for a variety of physicians). The results of that will tell you if you need to dig further...with a specific provider, with a certain LOS or procedure, or if they don't get the concept at all. And if you've identified a specific issue, focus your audit on that.
Any claims that you identify as being coded incorrectly through your audit should be reviewed with the coder so that they can comment on their rationale, as well as learn about any misconceptions that they have (or identify other issues that you may have to address within your EHR). By doing a pre-bill audit of your coders, you don't have to refund $$ if the coder isn't performing as you'd hoped.
We typically audit at 100% pre-bill for all new providers using our EMR coding function, to identify issues with documentation, template training, or diagnosis code selection problems. Once they've reached 90% accuracy consistently, we only do periodic audits to make sure they're maintaining the standard. During this process, however, our auditors\educators engage the providers in focused training, so that in the long run, we don't have to have a coder look at every single claim. We're comfortable with 90% accuracy, which sometimes you don't even get with soft-coded claims!
If you're auditing a new coder who isn't an auditor (CMPA), then I'd take a sample of their work pre-bill. (25 charts of a variety of services, over a 2-week period for a variety of physicians). The results of that will tell you if you need to dig further...with a specific provider, with a certain LOS or procedure, or if they don't get the concept at all. And if you've identified a specific issue, focus your audit on that.
Any claims that you identify as being coded incorrectly through your audit should be reviewed with the coder so that they can comment on their rationale, as well as learn about any misconceptions that they have (or identify other issues that you may have to address within your EHR). By doing a pre-bill audit of your coders, you don't have to refund $$ if the coder isn't performing as you'd hoped.
demorrison
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I am the coder trying to figure out how to check the coding function of our EMR. We are a small physicians office, so it's just me and 4 FTE providers. I also code for the ancillary for the hospital and the ER. I don't want to overload myself but I want to make sure that Everything is going out correctly. Thank you!
Pam Warren
True Blue
Because our EHR system is so problematic, and provider training by our IT team is not particularly comprehensive and long-lasting, we do look at every single claim prior to billing for all new providers. Yes, it's a lot of work, but it's better than re-work after an audit. Plus if we use our auditors to train providers early on as we identify the new issues, they're likely to maintain their skills in the long run.
Use the E&M audit tool published by your CMS contractor, or create your own based on the 95 or 97 guidelines. For procedures, look for informed consent, reason for the procedure, a narrative of the procedure, anesthesia type/administration, patient tolerance, any pathololgy sent, patient instructions and treatment or follow up plan.
Congratulations on realizing that an EHR is not foolproof. I know of a lot of organizations and consultants who throw the switch on a new EHR and let the claims fly out the door without a look-see. Your proactive approach is extremely important. Kudos!
Use the E&M audit tool published by your CMS contractor, or create your own based on the 95 or 97 guidelines. For procedures, look for informed consent, reason for the procedure, a narrative of the procedure, anesthesia type/administration, patient tolerance, any pathololgy sent, patient instructions and treatment or follow up plan.
Congratulations on realizing that an EHR is not foolproof. I know of a lot of organizations and consultants who throw the switch on a new EHR and let the claims fly out the door without a look-see. Your proactive approach is extremely important. Kudos!