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Accuracy in coding?

  1. #1
    Default Accuracy in coding?
    Medical Coding Books
    What would be a good percentage of accuracy in an audit for surgery coding?

  2. #2
    Location
    Quincy/Hannibal
    Posts
    67
    Default Accuracy
    When we audit providers, we recommend 90% accuracy. However, I always stress that if the provider's record were to be audited by a payer, they would likely not pay the claim if the record is inaccurate. Also, if the OIG were to audit a sample and find more than a 5% error rate (so 95% accuracy) they would likely investigate further. Its a good practice to have this in a compliance plan of what the acceptable accuracy rate for the practice is. Some practices are very lenient and allow 80%. I do not recommend anything lower than that.
    Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CHONC, AAPC FELLOW
    Regional Director, Audit Services
    www.healthicity.com
    lori.cox@healthicity.com

    2015-2018 AAPC National Advisory Board Member

  3. #3
    Location
    New Windsor, New York
    Posts
    1,183
    Default
    Quote Originally Posted by LoriCox View Post
    When we audit providers, we recommend 90% accuracy. However, I always stress that if the provider's record were to be audited by a payer, they would likely not pay the claim if the record is inaccurate. Also, if the OIG were to audit a sample and find more than a 5% error rate (so 95% accuracy) they would likely investigate further. Its a good practice to have this in a compliance plan of what the acceptable accuracy rate for the practice is. Some practices are very lenient and allow 80%. I do not recommend anything lower than that.
    We use 90% as the threshold for coding done by providers as well. For coding done by certified coders, whether professional and/or facility and whether at our hospitals or clinics, we use 95%. I know that threshold has been recommended by AHIMA, but I have to search to find that documentation.

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY

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