Panacea Clients Benefit from Well-Defined HIM Coding Audit Outcomes

In this current environment of increasing regulatory audits, decreased reimbursement, preparing for ICD-10 and other challenges, health information management (HIM) departments have much on their plates. Panacea has established its HIM Coding Audits program to handle these concerns, and customers have been very pleased that they can analyze many potential outcomes with a single audit involving a well-defined scope of work prepared in advance.

Recent HIM benchmarking data of Panacea’s audit results shows the following averages for findings. How does your HIM performance compare?

MS-DRG Accuracy – 91.9 %

ICD-9 Diagnosis – 91.3%

ICD-9 Procedure – 97.1%

CPT Procedure – 90.2%

CPT Modifiers – 88.4%

While coding is important, there are other questions that should be asked when determining what your audit outcomes should include. For example:

  • What is the goal of the audit – mitigating educational, regulatory or compliance risk; identifying financial risk or opportunity; or ensuring data integrity?
  • What should the sample be comprised of, and how should it be selected – randomly, focused or both?
  • What are the components of the audit?
  • How should results of the audit be reported?

Our clients often tell us they really had no idea about all the things they should be considering before defining the scope of their audits, expressing appreciation about how we explained the process and worked with them throughout it.

About the Author

Kim T. Charland, BA, RHIT, CCS is Sr. Vice President, Clinical Consulting Services of Panacea. A thought-leader in HIM with extensive clinical consulting services project management experience, Kim has 20-plus years in health information and reimbursement management for hospitals and physician offices. She is responsible for all aspects of Panacea’s clinical consulting products. Contact Kim at 800-252-1578 x3417 or at kcharland@panaceahealthsolutions.com.