HIM Audits

Clients call on us to conduct HIM audits for three 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.

Our HIM auditing experts do more than uncover your opportunities, risks and areas of improvement; they work with your HIM department’s staff to achieve and maintain a higher level of effectiveness.

HIM Inpatient Audits:

We recognize the importance of designating the appropriate sample methodology based on what you want to determine. To perform an Inpatient HIM audit, Panacea typically analyzes a sample of medical records to assess for appropriateness of diagnosis and procedure code selection using the ICD-9-CM Coding System, Present on Admission (POA) indicators, selection of MS-DRG, completeness of documentation to support accurate code assignment and appropriateness of Physician queries. We can also validate the Physician admission order, verify the discharge disposition, verify code transfer to the claim form, and MS-DRG payment received on the remittance advice.

HIM Outpatient Audits:

We recognize all the types of outpatient services that HIM can be responsible for from a coding perspective and the complexities of some of these areas. To perform an Outpatient HIM audit, Panacea typically analyzes a sample of medical records to assess for appropriateness of ICD-9 diagnosis and HCPCS / CPT procedure code selection, facility E/M (Evaluation and Management) modifiers, and completeness of documentation to support accurate code assignment. We can also validate the Physician order, LCDs and NCDs for medical necessity of services, verify code transfer to the claim form, and APC payment received on the remittance advice.

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