PIVOT Points

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To prepare for ICD-10, agencies must take their auditing to next level right away – Use these three tips to make sure your audit is working correctly:

Ensure your coders understand aftercare codes. Some confusion, for instance, lies in the fact that some conditions captured with aftercare codes in ICD-9, such as fractures and injuries, will not be captured with aftercare codes in ICD-10.

Make sure the group in charge of reviewing claims meets at least weekly. The titles of those who make up that group vary by agency, Twombly says.

But a core group should review that each of these claims has been coded properly and does not require additional review, Whitemyer says.

At some agencies, quality managers or compliance officers might be involved in reviewing claims, while other agencies might rely on peer-to-peer review, says consultant Arlene Maxim of A.D. Maxim Consulting in Troy, Mich.

Scrutinize the documentation coders are using in order to confirm the codes are supported. If problems are identified, it’s important to identify if there was a lack of documentation or a lack of coding understanding, Twombly says.

You may find that coders and/or nurses will require additional training. Use the audits to determine whether any documentation issues you discover in the audit are an across-the board problem or whether specific employees are struggling and require individual attention, Maxim says.

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