How coding complacency can cause problems when regulators come

Most healthcare organizations too routinely conduct annual coding compliance audits, a task required by the HHS Office of the Inspector General.

Too often, however, those within an organization responsible for doing the audit have gotten in the habit of doing it, but not thinking about it—it’s just done, says Karen Youmans, President and CEO at YES HIM Consulting.

But if regulators or health insurers arrive at a provider site, and the audit is not sufficient—containing low accuracy rates and education plans for any significant signs of poor coding processes—the company could face sanctions, she warns.

During an educational session at the upcoming AHIMA Convention & Exhibit, in Miami, Youmans will discuss how coding audits are the key to a successful and effective compliance program.

“Some providers have become too routine and complacent,” she says. “They haven’t studied audit results. They haven’t been using the expertise of consultants to re-educate coders and give presentations to doctors on ways to improve documentation.”



Consultants and auditors are ideal subject experts in helping providers address areas of concern that OIG or insurers will find in an audit, Youmans advises. “Hire an auditor before OIG comes in, as the auditor should be expected to catch any incorrect issues.”

The auditor who’s hired can read each coder’s reports and find omissions or other areas of improvement that can be made, she adds. “You need a partner to help vet specific irregularities in coding, and the person who coded should have a chance to demonstrate what they did and why.”

The session: “Coding Compliance Audits, Background, Statistics and Reports,” is scheduled at 1:30 p.m. on September 24 in Room 204 of the Miami Beach Convention Center.