HIM Audit and Validation Review Services
Clients call on us to conduct HIM audits for several reasons:
Coder proficiency – We can determine whether the staff is coding accurately and efficiently
Financial impact – We reveal missed revenue opportunities or overpayment risk
Medical necessity – We evaluate whether the services a patient is provided are medically necessary
Risk of mortality and severity of illness
Our Harmony HIM auditing experts do more than uncover opportunities, risks and areas of improvement; they work with your HIM department’s staff to achieve and maintain a higher level of effectiveness.
One of the first steps to complying with the governmental recommendations is accurate data and reported results from an un-biased expert auditor. Administrators can then use the data to ensure compliance with the OIG and to identify where opportunities for improvement exist. Whether it’s accuracy or workflow related, we work with you to refine or establish performance objectives and develop specific plans to achieve compliance and/or accuracy goals as well as workflow efficiency.
HIM Coding and Compliance Auditing includes:
- MS-DRG Validation
- APR-DRG validation
- APC Validation
- Coding Compliance Audits
- Coder Education and Training
- Pre-RAC Risk Assessment Reviews
- Appeal writing and denial
- Pre-Bill Reviews
Benefits of external auditing:
- Regularly scheduled auditing keeps performance and compliance on track
- Improved quality of existing coding staff
- Preparation of operational assessments and recommendations
- Identify and guide performance improvement and change management initiatives
- Identify missed opportunities
- Governmental Compliance
Harmony Health Audit implementation and Sample Work Plan
1. Preliminary interviews
Before every audit we conduct an interview with the appropriate contacts at the facility to discuss the exact goal or goals. We’ve found that many times CFOs want something different from a Director of HIM. Education is the priority for the departmental managers while improving certain revenue cycle processes and work flow may be the priority for others. The preliminary interview establishes set priorities for the auditor, and makes sure our clients receive the information they are paying for and expect.
2. Perform the Audit
- Now that we have established our objective we perform the audit and provide the following information as a part of our standard audit.
- Details from each case in spreadsheet format listing code, DRG/APC/HCC/etc., auditor, rationale for changed codes, accuracy ratings, and dollar differences
- Overall findings and trends of the audit including 5-10 financial impact analysis points for each
- Recommendations for education and remediation based on audit goals: within and outside of HIM
- Response to coder rebuttals or appeals
- Invitation to communicate with auditors about specific cases and questions related to something discussed in audit
3. Present Findings and Rollout Education
Following the audit we present our findings to the appropriate managers and/or officers and discuss in detail the information we have collected. If they find the information to be complete we will then typically set up a Question and Answer session with the coding team and provide an opportunity for rebuttals. Once that response is given we then formulate our final education plan for the facility.
Our typical follow up is within 2-3 months of our initial audit. We review a smaller sample size of charts to make sure the education is being implemented and the facility is receiving the return on investment they expect from the audit. The current climate of government scrutiny in healthcare dictates the need for a structured coding auditing and compliance program. The information we can provide will prove invaluable to your organization and keep you prepared for the uncertain levels of external scrutiny imposed by regulators. We are here to partner with you to provide the right solution to meet these requirements to make you successful.