Join us for a discussion about the gray areas of auditing for physician documentation and medical coding compliance in healthcare organizations. This webinar is an open questions and answers session about the challenges of medical record auditing.

Explore the Gray Areas of Auditing for Medical Coding Compliance

Join us for a discussion about the gray areas of auditing for medical coding compliance in healthcare organizations. This webinar is an open talk about the challenges of auditing medical records for accuracy and compliance.

Auditors must make many decisions about the interpretation of both government and commercial payer guidelines. Attendees of this webinar gained insight from expert presenters about what to do when they are stumped in an audit and are just not sure what to do. The discussion is not limited to evaluation and management (E/M) only.

A question example from the webinar: What is the main difference between a professional provider audit and a professional medical coder audit? Short answer: For a physician audit you are checking the medical record for accuracy and if they are including all relevant and complete documentation. When you are auditing medical coding, you are checking how the coder abstracted the codes from the provider documentation.

There are no slides for this presentation because it’s a question and answer (Q&A) session. Participants of this webinar brought their thoughts and questions and learned from each other.

Learning Objectives/Agenda

• What you can do when an audit is not going as planned?

• What makes something a “gray” issue in auditing?

• What auditing resources do you find acceptable and unacceptable?

• How do you agree to disagree, and when is it OK to do that?

• Do you have policies to clear up the gray areas, and if so, how is it working for you?

Why is this topic important?

Understanding the nuances of auditing medical records is important for your healthcare organization. It helps to ensure compliance that your healthcare providers are adhering to the increasing regulations and guidelines set by governing bodies such as the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG). Auditing identifies and manages potential areas of risk, such as fraud or abuse, which can lead to legal issues and financial penalties. It also promotes medical record accuracy by verifying that the medical coding and billing processes are correct, which is crucial for appropriate reimbursement.

Auditing to verify that medical record-keeping and coding are accurate also improves patient quality of care through clear and complete clinical diagnoses notes and the appropriateness of the treatment provided. Audits encourage continuous healthcare improvement by providing valuable insights that can be used to improve the efficiency and effectiveness of healthcare delivery.

Who would benefit from this topic?

• Auditors
• Consultants
• Compliance officers
• Coders and billers
• Coding and billing managers
• Practice managers

What’s the presenter's background/expertise on this topic?

Kipreos is director of provider auditor services for the Coker Group and has been working in the field of medical coding and auditing for over 30 years. She has been obtaining AAPC credentials since 1994 and incorporates her knowledge into the compliance audits she conducts. Kipreos has worked in a variety of practice settings and has specialized expertise in coding for family practice, urgent care, OB/GYN, general surgery, Medicare’s Teaching Physician Guidelines, with a particular emphasis on compliance with E/M guidelines. She is a past president of both the Richmond and Charlottesville, Virginia, local chapters of AAPC. Kipreos also served as the president for the AAPC National Advisory Board from 2013-2015. She received a Bachelor of Science in Finance from Virginia Tech.

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