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Coding Audit Process Improvement and Customization

As a valued member of your organization’s compliance team, the compliance auditors view process improvement as an integral part of developing an efficient audit program. Whether your organization is starting a system from scratch or seeking to refine the structures already in place, the opportunity exists to evaluate current tools and make an informed decision about how they can better serve the everyday needs of the folks utilizing them.

There are many considerations to keep in mind when developing an internal audit process specific to each organization. There are, of course, elements that must remain fixed, as they are dictated by outside entities (e.g., coding and payor guidelines). Keep in mind all the aspects that make each organization unique, and consider the following:

  • Who will be utilizing these forms/processes?
  • What roles does the compliance/audit team fill in different situations?
  • How can this work inform other departments on related processes?
  • What does accountability look like in the current process, and can it be enhanced?

For example, one of the many important tasks that the compliance department participates in is the implementation of new services. Let’s say one of the practice leaders attends a conference and hears of a service they would like to offer at your organization. Service implementation is a unique opportunity to coordinate with multiple departments and involves so much more than providing a new service to patients. Your team has the chance here to show their additional value beyond risk reduction through regular audits.

By outlining a start-to-end methodology for service implementation, organizations would have a paper trail, which would serve as a valuable reference should there be a guideline or personnel change. Additionally, this can help reduce duplicative work, saving time and money. This process could include, at a minimum, the following:

  • Identifying stakeholders
  • Performing and reporting on payor research (e.g., reimbursement, documentation requirements, any NCD or LCD, etc.)
  • Creating timelines for implementation
  • Coordinating EMR builds and clinical workflows
  • Envisioning how clinical workflows can complement back-end processes
  • Providing education to clinical staff
  • Providing education to non-clinical staff
  • Integration of these services to the audit process

Often, the most significant barrier to accomplishing a process refresh is the time it takes to sit down and make the revisions. However, making regularly scheduled space for improving processes will add efficiency, value, and time back into your regular work.

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