Wiki Coding accuracy rate

[MnTwins29]

We are in the process of rewriting our auditing policies. Under the old policies, a physician was deemed to have satisfactorily passed an audit if he or she had an 80% accuracy rate (docs do their own coding in the EMR and encoder). Many believe, including myself, that this is too low, but for physicians what would be acceptable? There is much literature that uses 95-98% for coders, but those are coders - people who are trained in the profession, whereas most physicians are not. So, I am hesitant to use that standard. Another wrinkle - our chief compliance officer says we should make it 100%, because after all, isn't that what we want? My response is yes, of course we want that, but then we risk being out of compliance with our own policy with every mistake. Being human beings, 100% will not be reached all the time. So, what is a good middle ground here? What do others whose physicians do the coding set as the acceptable accuracy rate?

Thanks!

 

[mdoyle53]

What is your current accuracy rate?

Medicare only expects 95%!!

I know coders are trained but if the doctors are doing the coding, then they are obviously trained also so the bar should be the same as for coders. I am sure your org would provide further training is requested so since they are coding, the standard should be in the 95% region.

 

[MnTwins29]

Too low

Our current policy allows 80%, which is far too low (I didn't write that policy!). As for the training the doctors recieve, they have recieved training on the EMR's encoder, not formal coding training. At least not yet - I am on a "world tour" where I give basic E/M training to docs at each of our practices.

Thanks for the thoughts - 95%, huh? I guess if Medicare calls for that, it's as good a source as any for citing to set it there. At least it isn't the 100%!