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Thread: Auditing Coders

  1. #1

    Question Auditing Coders

    AAPC: Back to School
    What rights (if any) do coders have regarding an audit? Can they question the audit findings and defend their codes or does the auditor have the last word?

  2. #2
    Join Date
    Apr 2007
    Swainsboro/Statesboro, GA

    Default Who is the auditor?

    I think the answer to your question depends on who is auditing you or your organization. If it's a private contractor, you should be given the opportunity to discuss the findings. When it's a government contractor, you may or may not be given the opportunity. Of course with the RACs, you can go through the appeals process, much like you can now with your MAC, FI or carrier.
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    I agree with the above. Also I hink it depends on how you are doing your job. I audit a significant number of coders, most of whom are certified, that never look at the documentation. They use the superbill/encounter form and code from that. In that case there is no recourse for the coder if errors are found. I had one tell me that if an AIC lab was circled on the superbill she would automatically add 250.01 as a dx to the list. Documentation is what drives the codes always and that seems to be a major problem. So I throw that out as an observation from one who does coder audits.

    Debra A. Mitchell, MSPH, CPC-H

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