Guest post: Random samples plus targeted audits yield best results

by Julia Hammerman, RHIA, CPHQ, and Sam Champagnie

An audit program that includes a balance of random sampling and focused auditing delivers greater insight into coder performance and documentation improvement opportunities under ICD-10. Begin with random sampling. This helps validate current performance across the entire organization and exposes previously unknown challenges. This approach ensures each coder has a random sample of charts audited on a frequent, consistent basis—ideally monthly, or quarterly at a minimum.

When random sampling results are aggregated, managers gain a clear understanding of the entire organization’s performance and can begin to identify opportunities for education and coding improvement.

Follow the sampling with targeted reviews. For example, after conducting education, target the audit to pinpoints which coders responded to the education and which ones need another round. It also shows areas of opportunity that might not have surfaced during the random review.

Data analysis from the focused audit can be used to fine-tune coder training for the entire group or individual staff. For instance, we know coders are making errors in spinal surgeries, cardiac surgeries, and respiratory diseases, so those areas should be included in focused audits.

Another important shift in ICD-10 coding audits is the need for faster and more frequent one-on-one coding education. Auditors must be able to quickly interact with coders to share results while also providing education. Prompt feedback to coders yields better results.

However, there are two common coding education challenges. Many organizations lack the management discipline and budgetary commitment to perform training immediately after coding audits. And, trainers aren’t always effective in delivering education based on individual coder preferences. A given educational plan might suit Coder A better than Coder B, for example.

Healthcare organizations invested significant resources on the journey to ICD-10. Now they must begin to recoup that investment. One way to do so is to revamp coding audit practices. In addition to greater frequency and a blended review approach, the following four tactics are suggested to turn audits into a positive financial endeavor versus a check-the-box compliance exercise:

• Know your training platform and content. Trainers must know the material inside and out and be able to help staff through the materials.
• Focus on every code. Not every coding error affects the DRG, so auditors should focus on every code, regardless of its DRG impact, so coders can truly master ICD-10.
• Combine audits and education. Coding audits shouldn’t stop short of getting organizations where they need to be in terms of coding education. Auditing and educational efforts must work in tandem.
• Use qualified auditors and educators. Don’t assume that great coders will also be great auditors or educators. It takes a special person to deliver education effectively and know when someone is absorbing the information.

Coding audits and education improve coding performance, help ensure ICD-10 coders hit the mark, identify opportunities to achieve coding compliance, maximize healthcare reimbursement, and fuel long-term ICD-10 education programs. Redesigning the audit process to address new ICD-10 challenges will help organizations meet coding goals.

Editor’s note: Hammerman, director of compliance and education, has more 30 years of leadership experience most recently as the enterprise HIM operations manager for BJC Healthcare.

Champagnie, senior director of HIM operations at HIMagine, has 23 years of healthcare business management experience. Opinions expressed are those of the authors and do not represent HCPro or ACDIS. This article originally appeared in HIM Briefings.