Coding Audits For Ehr Generated Codes ? Is It Necessary?

Posted by Ecareindia on April 29th, 2013

Over the past few years, the healthcare domain has been witnessing revolutionary technological advancements. Among them, the integration of auto-coding engines into the EHR systems was considered an extraordinary breakthrough as it eased out physician practices to a greater extent by allowing them to pick the Codes easily. Besides keeping track of the patient demographics, this upgraded system assignsCPT codes automatically. Though its coding functions are precise to a certain level, some serious errors do occur which go unnoticed during claims processing. Therefore, medical billing and coding audits has to be performed. Read below to understand why such audits are necessary,

Risks Involved with no audits on EHR Coding:

• The main risk involved with EHR generated codes is up-coding, which inflate healthcare costs for services actually not rendered by Providers and Hospitals. When payers come across this through audits, they perceive it as fraudulent activity and then the subsequent consequences and penalties would be severe.
• An overuse of EHR templates can lead to Auto Negatives, which again result in over-documenting and reporting for services not provided. It is because of these reasons that healthcare providers and medical billing companies are forced to perform medical billing and coding audits before processing claims. Probably, this solution can help keep the revenue cycle management balanced and unaffected.  
• The auto-coding EHR system uses cloning methods, which save documentation time, but cause serious problems in the medical billing and coding process.

Periodic Reviews: As explained earlier, manual audits must be performed periodically to avoid up-coding and putting the practice under the risk of being penalized by payers. The other possibility is down-coding, which if identified will enable a practice/hospital to set right and stem the loss of revenues from coding lower than actual services performed.  The auditors must keenly look for cloning errors and eliminate them on time. Also, they must review the voice recognition-transcribed notes, as they can also cause up-coding affecting revenue cycle management. It should be remembered that the EHR only suggests the Codes and it is the Provier who selects them! A timely review and correcting the codes will definitely consume a lot of time not to mention the additional expenses.  But, it is worth doing this instead of facing a Payer audit and potential refunds. Therefore, it is advisable that providers and medical billing companies outsource a part of their medical billing and coding services to reputed offshore companies like e-Care India.   

About e-Care India:

e-Care India is one of the renowned medical billing companies in India that promises the above mentioned benefits with total customer satisfaction. With 13 years of experience in the industry, e-Care’s offshore medical billing delivery centers have been providing end-to-end medical billing and coding services seamlessly to its clients. To know more about e-Care and its services, log on to www.ecareindia.com