ICD-10 Auditing Services

We understand how imperative it is for hospitals and health systems to maintain accurate code assignments to optimize reimbursements that accurately reflect quality services and minimize regulatory and compliance liabilities. ECLAT Health Solutions provides comprehensive auditing services to support hospitals and health systems focused on inpatient, outpatient, and pro-fee coding for ICD-10-CM/PCS, CPT-4 and HCPCS code sets.

Ongoing quality audits help our clients better understand the return on investment (ROI) and accuracy of each individual coder on their team as well as their investment in external contract coding resources. In addition to monitoring and improving the accuracy of coders, ECLAT identifies clinical documentation improvement (CDI) opportunities to make sure physicians are providing accurate and complete documentation resulting in decreased queries, and accurate and specified code assignment.

Customizable Frequency & Sample Size

The frequency of audits can be tailored to meet the specific needs of each individual hospital or health system. Services can be availed per clients’ needs bi-annually, quarterly, or other desired parameters depending on the interest and goals. Support can be provided on all chart types, specific chart types, specific coders, high alert cases (RAC, OIG, etc.), or other focused areas (MS-DRG, ROM, SOI, APR-DRG, APC, POA, etc.). ECLAT can accommodate your preferred sample sizes or provide the recommended sample sizes for different charts types and/or code sets to be audited.

Specialties & Expertise

ECLAT provides expert auditing services focused on the following areas. Customer has the option to pick and choose individually from ECLAT’s many services:

  • Inpatient medical records including assignment of ICD-10-CM and ICD-10-PCS, as well as, MS-DRG and/or APR-DRG assignment, Present on Admission (POA) indicators and Discharge status.

  • Outpatient same-day surgery (ambulatory surgery) medical records including assignment of ICD-10 CM diagnosis and ICD-10-PCS (if applicable), CPT4 procedure codes and modifiers, and HCPCS codes, wherever, applicable.

  • Observation medical records to include assignment of ICD-10-CM and ICD-10-PCS, CPT 4 codes and HCPCS codes, wherever, applicable.

  • Emergency department medical records including ICD-10 CM, CPT4 codes and modifiers, as well as, Evaluation and Management (E&M) Levels for Professional or Facility components, injections and infusions, wherever, applicable.

  • Outpatient ancillary medical records including assignment of ICD-10 CM and CPT4 codes wherever applicable.

  • Physician professional services including ICD-10 CM codes, Evaluation and Management (E&M) level, CPT4 codes and modifiers wherever applicable.

  • Clinical documentation improvement (CDI) opportunities.

ECLAT follows official coding guidelines and references (such as Coding Clinics, CPT Assistant, NCCI, NCD/LCD, OCE and MCE), in addition to Customer-specific guidelines to the extent such guidelines do not contradict official resources. Payer-specific requirements are also taken into consideration.

Additional Focus Options

ECLAT can provide your practice with the following focus options, if requested:

  • Validation of principal diagnosis, first listed, and/or principal procedure selection/assignment.

  • Validation of all secondary MCC, CC, and other reportable diagnosis and/or principal procedure selection/assignment, in addition to logical sequencing regardless of impact to MS DRG or APC calculation to ensure overall coding quality (full code review).

  • Validation of discharge disposition and transfer status.

  • Operational assessment related to coding (i.e. – incomplete source documentation for accurate coding and workflow).

Also, wherever noted and/or requested, ECLAT will document discrepancies with the following:

  • Compliance with potential fraud and abuse issues per HIPAA and HITECH regulations.

  • Compliance with federal/state and/or other regulatory entities.

  • Research and explanation of coding rationale related to appeals processes (e.g., Corporate Audits, RAC Audits, MIC Audits, etc.).

Audit Findings & Education

Education and training is a critically important part of any audit. Education and training are available to the following team members upon request: CEO, CFO, Controller, HIM Director, Coding Manager, Coding Supervisors, Coders, and Physicians.

  • Executive Summary outlining the overall scope of the audit and initial findings and results.

  • Final Report with findings by coder as well as overall facility performance for MS-DRG/APC and overall coding accuracy; where requested: discharge disposition, patient type, and POA assignment accuracy rates.

  • Financial impact analysis based on findings.

  • Education session for coding staff based on opportunities identified, and/or as requested.

  • Training on specific coding/abstracting/query logic (case by case option/assessment).

  • Debriefing session with desired hospital leadership team.

Experience Brilliance with ECLAT

The word “Eclat” means “Brilliance” in French, and we strive to live up to our name by crafting business partnerships that work brilliantly in a symbiotic nature. ECLAT Health Solutions offers flexible and comprehensive solutions for healthcare revenue cycle management services such as Medical Coding, Medical Auditing, and Medical Billing. Contact us to begin your auditing today!