By Chris Ekrem and Tracey Schuessler

The popular business adage is true in healthcare as well: what gets measured, gets managed. 

As healthcare professionals serve patients with compassion and quality care, an essential component of measuring that care is accurate coding. Whether you are a Critical Access Hospital providing a wide variety of multi-specialty services or a Federally Qualified Health Center providing a high volume of evaluation and management services, without up-to-date codes, proper documentation, and well-trained employees, you cannot be confident that you are charging correctly, complying with regulations, or getting a clear picture of the care you are providing your community. Regular code reviews are critical to keeping up with the constantly-changing codes/regulations and getting paid for everything you provided.

What is a code review?

A code review reveals error rates, which new codes are missing from the chargemaster, and areas where employees need more education and improvement. We recommend reviewing codes quarterly and measuring a small sample of patients—about five to 10 percent—from across the board, including surgery, ER, inpatient, outpatients, etc. From that sample, an examination of diagnostic codes, procedures, DRG accuracy and CPT-4 codes should reveal areas of error (as well as what is being done right). In addition, an analysis of the chargemaster is an important part of the review process to ensure that all charges are medically necessary.

What is the value of a code review?

Re-educate your staff.

With the industry-wide adjustments following the release of ICD-10’s completely new coding system, as well as new regulations announced in October and the annual update of CPT codes each January, hospital staff are constantly learning new codes and procedures. In addition, payers have updated allowable billing codes, and national and local coverage determinations must be considered. This is an overwhelming amount of ever-changing information for providers to process.

While no one can ever completely know ahead of time all the new rules and regulations, it can be learned. Coding reviews help healthcare professionals to continue to strengthen their “coding muscles,” and give organizations the opportunity to re-educate their employees, ensuring they are equipped to code correctly and confidently, allowing them to keep their focus on caring for their patients.

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