Quality assurance (QA) is a common term in medical coding. According to AAPC, QA is the process of looking at how well a medical service is provided. The process may include formally reviewing healthcare given to a person or group of persons, locating the problem, correcting the problem and then checking to see if what you did worked. As with any process, the interpretation of medical coding quality assurance can vary across healthcare organizations and the vendors who serve them.
As an HIM director, coding manager or revenue cycle executive, how do you define coding QA? Do you follow specific steps and actions to ensure its effectiveness?
At KIWI-TEK, a proven QA process is a requirement for success, for our coders and for our clients. We take ownership of the work our coders do, and we do this with QA as the foundation.
Our philosophy is steadfast: when it comes to correct documentation, coding and reimbursement, never underestimate the power of coding quality assurance. Here are a few essential methods to ensure a powerful coding QA process.
We review 100% of all the work coders do when they’re placed on a new client assignment. Once we’re certain a coder is achieving 95% QA consistently, we put them on a monthly QA schedule. We encourage each of our coders to take full ownership of the charts they’re coding, and we stand behind them by reviewing those charts. Our coding team tells us it’s reassuring to know that their work is analyzed to hold them accountable and provide educational opportunities.
Look for Trends
Are coders struggling with a new Covid code? Is there confusion with a new query? Looking at monthly trends allows us to target coder education. This analysis also serves as an accountability tool on both sides—for the client on how we’re performing and for the coder on their quality. From the client’s perspective, they get reassurance that any gaps are being addressed, not just reported out with no action. From the coder’s perspective, it could be a sign to focus and not rush because your chart could be pulled at any point.
Create an Action Plan
Taking ownership and looking at trends are important strategies that lead to the crucial piece—an action plan. In our monthly reports, we make sure to include details about the points applied to every coding decision made. By sharing our weighted methodology that correlates to impact on reimbursement, we explain the gaps and opportunities for our coders and our clients. An action plan might include 100% review of specified account types, an education session, a one-on-one Zoom training session, and other services. If you’re interested in seeing a sample report you can request one here.
Harness the Power of Coding Quality Assurance
We understand that you need more than coded and billed charts. Accuracy, compliance and full capture of billable procedures are crucial. For more information about how KIWI-TEK helps clients with coding quality assurance and more, contact us today.