Integrating Performance Excellence and Business Strategy

Managing Coding, Audit, and Clinical Documentation Integrity

In the business of healthcare, it is vital that hospitals, health systems, and physicians adhere to accurate coding and billing processes. That includes relevant documentation of medical records, precise application of billing codes, and proper charging of insurers for medical services rendered.

Risks to Providers

Submitting an inaccurate diagnosis, or a diagnosis resulting in a different hierarchical condition category (HCC), is a compliance risk. Any change in the HCC could result in the provider receiving too much or too little revenue.

The following is a list of common medical billing mistakes:

Reducing Risk

Clinical documentation integrity (CDI) is important - for hospitals and physician practices - coding is only as accurate as the documentation of the medical record. Patient care, data integrity, compliance and reimbursement are at risk when the severity of illness, treatment provided and mortality rates aren't detailed. That's why more providers rely on the CDI team to support medical necessity of the services provided, quality care and patient safety measures.

Auditing measures reimbursement accuracy, ensures compliance adherence and achieves quality assurance while reviewing procedures to ensure that the correct diagnosis related code (DRG) is assigned to the correct reimbursement is received.

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