Clinical Coding Auditing FAQs

Find answers to clinical coding auditing FAQs. Read on to find out why it is important to conduct regular audits, and what to expect from an external audit provider, like Resolutions.

Periodic auditing can be a vital component in your organisation meeting the requirements of funding contracts and regulatory compliance.

It can also be critical in identifying coding errors and missed revenue opportunities.

This section covers many of the key questions about Resolutions’ auditing services.

Why do I need ~ or why should I do ~ an audit?

There are three main reasons we conduct audits for clients. First, the client is trying to establish its financial position. Second, they are looking at the quality of their data and ensuring it meets all statutory and legislative requirements, including accreditation. Third, we audit as an educational focus for their coders.

Most clients think they know the accuracy of the coding within their organisation. Our view is that you can validate exactly where you sit when you have an audit conducted. Usually the client suspects an issue with the coding or they require an external third party to validate their financial position. We will keep auditing until we don’t find any more revenue OR we audit in accordance with your budget. That way, you can justify, and be confident of, your coding accuracy and its implications on revenue. It can also satisfy your health fund contract and accreditation requirements to assess coding quality.

How much does an audit cost?

Our experience has revealed that it costs more for an internal audit to be conducted by a client’s own staff because generally they do not have the tools or experience to conduct the audit. This means more time is spent on analysis and reporting. Manual systems also have a human error cost. The introduction of ResiCAT, our new coding audit tool, has reduced the cost of an audit by one-third. There are inbuilt validations in the tool, and reports, including DRG status, can be revealed on the last day of audit, reducing analysis costs.

The cost will vary due to the size of the audit and the casemix difficulty. When you use Resolutions, you are getting the best auditors in the country with vast experience that can locate lost revenue. We have been involved in the development of the Australian coding standards, have audited across many types of facilities and have a vast knowledge of the issues that cause coding errors and subsequently issues with revenue.

How often should I have an audit performed?

This depends on the reason for the audit, when the last one was performed and the size of the facility and specialties. Also the sample type can be an issue. We recommend that, if the facility has not been audited in the past two years, a random sample of approximately 1% be performed. Inclusions and exclusions (such as chemotherapy day patients) also need to be considered, depending on the reason for the audit.

Are there statutory requirements stating I need an audit?

Clients often opt to conduct an audit because of quality provisions in their health fund contract or accreditation requirements including quality and documentation auditing.

How do I prepare for an audit?

It depends on the reason for the audit. For example, a hospital may choose to do some analysis to target the audit sample. Our audit tool requires a data extraction from your patient administration system and then preparation to pull the medical records with plenty of time prior to the audit. Then we do the rest.

Why should I utilise Resolutions’ auditing services?

We audit to ensure you meet statutory and legislative requirements and we find potential revenue gains. At least you will definitely know the standard of your coding after having an audit.

How is a Resolutions coding audit conducted?

We can organise your sample through our web-based audit tool ResiCAT. Just tell us how many records and your parameters. For example: selection by DRGs, codes or other parameters such as coder ID. You pull the sample and we upload the file and off we go. We pride ourselves on the conduct of our audits and the interpersonal skills of our auditors.

We conduct an interview at the commencement of the audit, review changes in accordance with your requirements on a daily basis. We conduct an exit interview and then we print off your report on the final day. You receive an output file and specialised coding output report. Coding is not an exact science so feedback is encouraged. Coders and their opinions are treated with respect.

What are the qualifications of Resolutions’ auditors?

All of our auditors have been auditing for ten years or more with both national and international experience. They have all been involved with development of the Australian coding standards at some stage and have all worked in every state and territory in Australia. We allocate auditors in accordance with their experience and casemix specialty.

What reports will I receive from an audit?

Our audit tool ResiCAT offers a range of reports including DRG, auditor summary of codes, output file of all data fields and many more. For example, you may set values such as ‘Yes’ or ‘No’ for whether an acute care certificate has been completed. Our tool also provides the opportunity to audit hospital-defined fields and quality audits such as those criteria found in QPS benchmarking.

What other types of audits does Resolutions provide?

Resolutions performs casemix, revenue, documentation and accreditation audits focusing on the health information area.

Any auditing question not shown here?

Please Contact Us to get in touch and find out more.