Inpatient Auditing & Compliance

Inpatient auditing and compliance review of medical coding are essential components of healthcare management. They ensure accurate coding of medical services, adherence to regulatory guidelines, and overall compliance with established standards.

Code Billium (CB) specializes in this critical auditing function and can help your organization avoid financial penalties, loss of reimbursement, legal issues, and reputational damage resulting from inaccurate coding.

Inpatient Auditing Services Provided by CB

The types of inpatient auditing that Code Billium provides include:

• Comprehensive Coding Quality Reviews
• APR-DRG Reviews
• MS-DRG Reviews
• Top 5 MS-DRG Reviews
• Query Reviews

Why Is Inpatient Auditing & Compliance So Important?

Accurate coding in hospitals, physicians’ offices, and other healthcare entities is crucial for various reasons, including billing, reimbursement, and statistical analysis. It also helps ensure proper communication between healthcare providers, insurance companies, and government agencies.

In terms of regulatory guidelines, inpatient coding must adhere to several standards, including:

• ICD (International Classification of Diseases) coding system
• CPT (Current Procedural Terminology) system

Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is also essential to protect patient privacy and ensure secure handling of health information.

The CB Auditing Process

When performing an inpatient audit, the expert consultants at Code Billium follow a detailed and comprehensive review process. The following are the key steps involved:

• Review your team’s expertise in MS-DRG, APR-DRG, and ICD-10-CM/PCS
• Evaluate the completeness of documentation to support accurate code assignment
• Assess the appropriateness and applicability of physician queries
• Validate physician admission orders
• Verify proper discharge disposition
• Ensure the correct code transfer to claim forms and ensure accurate MS-DRG payments are received on remittance advice

Avoiding Consequences of Non-Compliance

Inaccurate coding or failure to comply with regulations can lead to severe consequences, including:

• Financial penalties
• Loss of reimbursement
• Legal issues
• Reputation damage

When you partner with Code Billium for inpatient auditing and compliance, you can be assured that your organization will adhere to all best practices and regulatory standards.

Ongoing Monitoring and Improvement

Regular audits and monitoring processes are crucial in identifying areas for improvement. Continuous feedback and education help enhance coding accuracy and compliance over time. Code Billium is your ongoing partner, conducting regular audits and providing employee education to ensure your organization is always compliant.

Contact CB Today

If your organization could benefit from an expert, third-party audit of your inpatient medical coding process, contact us today.

Call us at (737) 377-6697 or fill out our Contact Form.