Compliance
Developing action plans to address identified non-compliance.
Corrective Plans
Pre-bill, Post-bill, Retrospective, Concurrent
Type of Audit
Tools that assist in code selection and provide edits.
Encoder Software:
Facilitating clinician queries to clarify documentation inconsistencies or missing information.
Communication channels
Reviewing documentation and codes before claims are submitted.
Prospective Audits
Software that suggests codes based on documentation analysis.
Computer-Assisted Coding (CAC)
Outline expectations for accurate code selection, documentation requirements, and ethical coding practices.
Policies and Procedures
Reviewing documentation and codes after claims have been processed.
Retrospective Audits
Programs designed to facilitate coding audits and reporting.
Audit Software
Monitoring audits and ongoing improvement
Audit and Monitoring
Focusing on high-risk areas, specific payers, or new services.
Target Audits
Proper configuration and use of EHRs to prompt for necessary documentation and codes.
Electronic Health Record (EHR) Systems
Trends that may cause risk and therefore requires additional attention
Escalation
General reviews to assess overall accuracy. These audits help identify errors, determine root causes, and measure compliance effectiveness.
Random Audits
RAD
Rapid Application Development