Coding Quality and Auditing
Coding Quality should be measured by a cycle of Review – Plan – Act. This facilitates ongoing coding & documentation quality and a level of confidence that the methods implemented to ensure a suitably skilled, qualified, established workforce have achieved their desired outcomes & that measures are in place to act proactively to rectify issues as they arise. Quality plan outcomes should be reported to Organisational Executive on a regular basis.
Amongst other, audit specific required outcomes, the quality plan encompasses regular audits and quality checks to:
• Validate the accuracy of the coding and appropriate completeness of the documentation to facilitate accuracy in coding;
• Ensure the episode has been grouped to the appropriate & accurate DRG complexity split within relevant adjacent DRG groupings;
• Identify deficiencies and recommend opportunities for improvement by highlighting areas where coder education is required & where clinician education regarding documentation is needed.
It considers analysis and ad-hoc review of underperforming units (* Reliant on local reporting capabilities) and high level review of coding quality across the organisation, in line with Health Department required reporting, adjustors and quality checks & perceived education & development needs of clinical coders. It identifies opportunities for the CDIS team to educate clinicians to improve the complexity as reflected in clinical documentation to that which it actually should be.
It is recommended that at least 5% of separations be reviewed to be statistically relevant to the overall population of episodes. Results can be benchmarked and trended quarter on quarter and year on year to demonstrate coding & DRG quality over time.
If you need assistance with implementing a Coding Quality Plan at your facility, or you simply need advice on how you can improve your existing Coding Quality Plan then contact us at The Coding Company for help.
Clinical coding audits are an essential requirement in all public and private health services. At TCC our highly experienced contract coding audit team has the ability to perform all quality and funding optimisation audits across any casemix complexity level.
Our auditing services will ensure that your facility is maximising its revenues, whilst also meeting all funding compliance requirements.
Our highly-skilled Health Information Managers and Clinical Coding Auditors can provide you with the results and management tools necessary to help you get the best out of your health information.
We’ve conducted hundreds of contract coding audits in the public and private sector, both onsite and remotely, across Australia. Our Auditors will audit an agreed number of episodes per day during the contract, and will provide a detailed Audit Report along with follow-up and feedback to your clinical coding team as part of our Qulaity Improvement Strategy.
For more information please contact Linda Westbrook