The checks and balances of an edit, review and audit process

Prospective review or retrospective audit: Which is more effective?

Coding accuracy reviews and audits are designed to ensure health care organizations provide the most accurate and compliant representation of the patient care provided. There are multiple ways in which coding and compliance functions provide checks and balances to verify coding accuracy, including custom edits, second level reviews and retrospective audits.

When looking at these different processes, which is more effective for ensuring coders are accurate, and work through the most complex coding issues? Trick question! The answer is: All of them.

Each function plays an important role in confirming the highest coding accuracy throughout the coding session, along with the “balance” of a retrospective audit that targets high risk coding areas, and/or the need for additional coding education. 

Dive deeper into how each of these elements is essential to coding accuracy and revenue integrity.
Read the article on the National Association of Healthcare Integrity (NAHRI) website.

Keri Hunsaker is a marketing manager at 3M Health Information Systems.