Clinical Chart & Coding Audits

TriumpHealth also offers Clinical Chart & Coding Audit services which involves a thorough review of clinical documentation and coding for accuracy and compliance with industry standards.
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MEDICAL BILLING & REVENUE CYCLE MANAGEMENT

Clinical Chart & Coding Audits

Healthcare organization lose a significant amount of revenue annually due to their inability to identify claim coding errors that contribute to charge capture leakage. TriumpHealth’s proactive coding and medical necessity documentation audits help discover hidden revenue opportunities to ensure that we proactively correct claim errors to maximize reimbursement and coding compliance.

Predictive analytics and rule-based audits verify the claims regularly to prevent missing, duplicate, under, and over charges. TriumpHealth’s claims auditing team detects missing claim codes for both institutional and professional charges. In addition, the team assesses each claim for CPT and ICD-10 code sets to identify incorrectly coded claims. We investigate the integrity of charges by scrutinizing whether claims should have been bundled, examining medical necessity policies, and identifying charges posted in error.

clinical audit

Frequently Asked Questions

What is a clinical chart and coding audit in healthcare, and why is it essential for medical practices?

A clinical chart and coding audit in healthcare involves the review of patient medical records and associated medical codes to ensure accuracy, completeness, and compliance with regulatory requirements. It is essential for medical practices to maintain high-quality documentation, ensure appropriate coding, and minimize compliance risks.

How do you conduct clinical chart audits, and what specific elements are reviewed during the process?

Clinical chart audits are conducted by trained professionals who review patient medical records, documentation of services provided, and associated medical codes. Specific elements reviewed during the process include patient demographics, medical history, progress notes, diagnoses, procedures performed, treatment plans, and coding accuracy.

What role does accurate medical coding play in the clinical chart audit process, and how is it ensured?

Accurate medical coding is crucial in the clinical chart audit process as it ensures that the services rendered are properly documented and billed. Coding accuracy is ensured through regular training for coding staff, utilization of coding guidelines and resources, and ongoing monitoring of coding practices.

Can you explain the significance of coding compliance in healthcare and the impact it has on reimbursement and regulatory adherence?

Coding compliance in healthcare is significant for ensuring accurate reimbursement, maintaining regulatory adherence, and minimizing risks of audits or penalties. Non-compliance with coding guidelines can lead to claim denials, revenue loss, legal implications, and damage to the reputation of the medical practice.

How do you handle discrepancies or errors identified during a clinical chart and coding audit, and what corrective measures are implemented?

Discrepancies or errors identified during a clinical chart and coding audit are addressed through corrective measures such as retraining staff, updating documentation processes, implementing coding checks and balances, and conducting regular audits to monitor compliance. It is crucial to rectify errors promptly to mitigate potential financial and regulatory risks for the medical practice.

Our Process

1

Chart Retrieval and Review

Obtain clinical charts and documentation related to patient encounters from healthcare facilities or electronic health records (EHR) systems.

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2

Coding Audit

Evaluate the accuracy and completeness of medical codes assigned to diagnoses, procedures, and services documented in the clinical charts, ensuring alignment with coding guidelines and regulations.

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3

Documentation Review

Assess the adequacy and clarity of clinical documentation to support the assigned codes, identifying any discrepancies or deficiencies that may impact billing accuracy or compliance.

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4

Audit Reporting and Recommendations

Compile audit findings into a comprehensive report, highlighting areas of improvement or potential compliance risks. Provide recommendations for corrective actions or additional training to enhance coding accuracy and documentation integrity.

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Benefits of Working with TriumpHealth

Clinical Chart & Coding Audits

1

Reduce After-Hours Coding Review

Transition to our enhanced coding review and claims validation process and eliminate late night and week-end work for charge review.

2

Eliminate Expensive Coding Resource

Finding, training, and retaining coding talent can be challenging and expensive, trust us to provide experienced resources for you.

3

Increase Reimbursement

By proactively auditing incorrect codes, bundling issues, missed coding opportunities, and documentation deficiencies we increase revenue.

4

Improve Compliance

We mitigate the risk of penalties, audits, and legal issues related to improper coding practices.

Top Rated by Healthcare Organizations

TriumpHealth has helped us with MU 
and PQRS since 2013, and now MIPS. TriumpHealth has worked well for us because of their systems and compliance knowledge.
Having TriumpHealth support us in these efforts keeps my office staff focused on the patients. For any clinic stuck using Allscripts, 
TriumpHealth can help.
Joy Schwartz, Office Manager Atlantic Surgical Group (Gastroenterology)
TriumpHealth has helped us with MU 
and PQRS since 2013, and now MIPS. TriumpHealth has worked well for us because of their systems and compliance knowledge.
Having TriumpHealth support us in these efforts keeps my office staff focused on the patients. For any clinic stuck using Allscripts, 
TriumpHealth can help.
Joy Schwartz, Office Manager Atlantic Surgical Group (Gastroenterology)
TriumpHealth has helped us with MU 
and PQRS since 2013, and now MIPS. TriumpHealth has worked well for us because of their systems and compliance knowledge.
Having TriumpHealth support us in these efforts keeps my office staff focused on the patients. For any clinic stuck using Allscripts, 
TriumpHealth can help.
Joy Schwartz, Office Manager Atlantic Surgical Group (Gastroenterology)
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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.