5 Reasons Why Coding and Documentation Audits are More Important than Ever

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5 Reasons Why Coding and Documentation Audits
are More Important than Ever
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• Auditing is an integral aspect of governance and
  quality management for organizations across
  industries. Many healthcare organizations adopted
  new electronic health record (EHR) technology
  with the implementation of ICD-10 (International
  Classification of Disease, 10th version).
• It outlined unprecedented detail in
  record-keeping, with over 71,000 procedure
  codes from just over 3,800 in the previous ICD-9.
  In order to make the most of a system as
  intricate as this, healthcare providers would do
  well to adopt solutions driven by technologies
  powered by natural language processing (NLP) and
  artificial intelligence (AI). This would lead to
  fewer errors in data and billing, and thereby
  fewer payment lapses.

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The Growing Need for Audits

• Medical coding audits seek findings that support
  the implementation and enhancement of clinical
  documentation improvement (CDI). Auditing CDI
  teams can optimize diagnosis-related groups
  (DRGs) as well as retain and hire the right staff
  that can maximize revenue.
• Initiatives such as the Recovery Audit Contractor
  (RAC) program by the Centers for Medicare and
  Medicaid Services (CMS) have proven the need for
  effective CDI by recovering millions in improper
  payments in Medicare and other insurance schemes.

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Here are five reasons why audits are more
important than ever Enhanced Data
Quality  Reliable data is a cornerstone of
healthcare. The right compliance auditing
program, along with informed stakeholders, a
rigorous feedback loop, and consistent follow
ups, significantly increases the quality of data.
This leads to better reporting and research,
making it easier for healthcare organizations to
win funds or grants.
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• Higher Operational Efficiency Manual medical
  coding and billing is a big challenge for
  providers everywhere. Each manual transaction
  costs 4.40 more than each automated transaction,
  according to the 2018 CAQH Index Report. The same
  report states that automating claims-related
  dealings can save healthcare providers around
  11.1 billion yearly, yet the industry has made
  modest progress in transitioning from manual to
  fully automated transactions.
• Automated auditing can detect various errors and
  also shine a light on the root causes of coding
  and documentation discrepancies. This can even
  improve employee morale and productivity if seen
  as complementing their work instead of
  supplanting it.

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• Improved Patient Safety According to an article
  in the International Journal for Quality in
  Health Care, internal auditing decreased
  patient-related adverse events by 4.8. 
• With timely detection of errors and instant
  feedback to medical personnel, real-time auditing
  can enhance patient safety.
• Changes in clinical policy and practice can be
  ushered in with confidence, since auditing will
  pinpoint the areas where lapses exist.

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Improved HIM-Physician Relations Properly
executed audits by health information management
(HIM) staff will root out documentation errors
induced by all involved parties, including
physicians. With correct practices in place,
these two primary stakeholders in patient care
gain a better understanding of how their own work
processes affect the other. Physicians who
frequently make errors in documentation can work
with HIM personnel to learn more about the right
practices. Regular feedback and increased
transparency will ensure better quality work.
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Enhanced Accuracy of Reimbursements Underpayments
and overpayments have plagued hospitals and care
centers for a long time. According to a CMS
report submitted to the U.S. Congress, RACs
recovered 214.09 million during the 2016 fiscal
year. Correct auditing practices will ensure
proper documentation of complications and
comorbidities (CCs) and their major variants
(MCCs). The seriousness of any illness is, of
course, decided by the presence or absence of CCs
and MCCs, which determines payment for hospital
services. In short, correct auditing can
recognize these lapses in billing processes and
ensure that both organizations and patients get
the reimbursements due to them.
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Case in Point a Syracuse Hospital Halves DNFC
and Saves 1 Million
In 2016, Auburn Community Hospital (ACH), a
not-for-profit acute care facility in Syracuse,
New York, experienced difficulties with their
encoder software while completing their coding
and CDI-related work. Their discharge not final
coded (DNFC) was seven days and they had a case
mix index (CMI) of 1.2024. ACH needed to
eliminate coding backlogs, assign accurate ICD-10
procedure codes, and improve coder efficiency.
The facility needed customized worklists and an
intelligent platform that could track missing
documents and recognize opportunities for CDI.
Their DNFC and CMI needed immediate improvement
as well.
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At ezDI, we believe healthcare organizations need
to adopt the right NLP-based auditing
application. Such an application can automate
manual processes, enforce smart wordlist
prioritization, auto-generate evidence-based
queries, and more, all on a collaborative single
platform. These were the benefits we were able
to provide ACH when the hospital decided to
leverage ezDIs NLP-based technologies. This
included the computer-assisted coding (CAC)
application, ezCAC, a fully integrated encoder,
ezEncoder, and ezAssess, ezDIs coding compliance
software.
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Our applications went live at ACH and, in the
course of a year, the organization
experienced 4.59 increase in CMI by
improvement of the complication/major
complication (CC/MCC) capture rate, resulting in
optimized DRGs 50 decrease in DNFC days from
the initial 7 days to 3.5 days, leading to
greater cash-on-hand
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Over 40 improvement in coder efficiency by the
provision of automated code suggestions to
coders Elimination of all IT support through our
cloud-based technology ezDI helped ACH better
their revenue cycle process, where the
bottom-line impact after a year was 1 million.
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Achieving New Heights with AI and NLP
It is imperative for healthcare organizations to
adopt rigorous auditing practices that promote
employee performance and organizational
transparency. While AI-based NLP auditing tools
have become more popular, only organizations that
choose the right vendor-cum-partner will witness
a robust return on investment (ROI). ezDI can
assist your organization to improve patient
outcomes and revamp your healthcare processes for
the future. To know more, subscribe to our
blog and to request a live demo, contact our
experts.
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Contact us Visit Our Website-
https//www.ezdi.com/ Phone no- (866)
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Louisville, Kentucky 40243