Who audits medical coders?

Conducting at least one annual coding audit is a requirement for compliance, according to the OIG. Moreover, the Centers for Medicare & Medicaid Services (CMS) and the OIG encourage all providers to regularly have their coding reviewed by an independent party proficient in their clinical specialty.

What is a coding auditor?

A coding auditor reviews and evaluates medical coding to ensure the accuracy of patient records and billing. You need extensive knowledge of ICD-9 and CPT codes to make sure that the medical coding documents you review are accurate and that patients receive accurate bills for their medical services.

How are coding audits performed?

Medical coding audits should include a select sample of patient encounters as coded and billed. To design an audit, identify strategic initiatives, such as performance measures, validation of coded claims, prevalence of diseases, and treatments and adherence to policies and procedures to ensure compliance.

What is a provider auditor?

Position Summary/Position. Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.

Why would an insurance carrier want to perform an audit?

The purpose of insurance premium audits is to use actual sales and operations data to determine how accurate their guess was. Your exposure basis is the data that the insurance company uses to calculate its expected risk, and with that the premiums to cover that risk.

How much does a coding auditor make?

How much does a Coding Auditor make? The national average salary for a Coding Auditor is $76,805 in United States.

What are the key components to be checked when performing a coding audit?

The key components checked in a coding audit include:

• Are the codes appropriate to the patient’s profile (age, gender, condition; new or established), and is each coded service billable?
• Is there a clear and correct link between each diagnosis and procedure?

How often should coding audits be done?

More frequent coding audits are now more commonplace. Best practice involves ongoing, consistent audits focused on 3.5 to five percent of total volume per month. Auditors adhere to a schedule to review sample cases every week.

How often are coding quality audits done?

Can your accountant also be your auditor?

Your accountant can act as the company’s auditors if they: don’t fall into one of the disallowed categories (see ‘Who can my company appoint as an auditor?’ above); don’t take part in the management of the company at all; and.

What should you look for when auditing?

Auditors are always looking for unreported business earnings, and will even look at your personal lifestyle, the furniture and assets you have in your home or your business, and other signs of wealth to determine whether or not they think you are making more money than you reported.