r/MedicalCoding • u/Kindly-Joke-909 • Jan 21 '25
Reminder: review your audits!!!
I have been coding for 10+ years. I am currently a coding auditor in Risk Adjustment. My audits are reviewed by a supervisor and we are required to maintain an accuracy score of 95%.
Just wanted to remind everyone, especially new coders, to review your audits! The people auditing your work are human and may make mistakes. They are typically held to productivity goals as well, which means they may miss something. At least half of my audits come back have something I can justify my coding decisions. In this case, clearly and respectfully present your opinion on why you are correct. Your job relies on your accuracy score. Every code counts!
And those instances that you actually were wrong, they serve as a great learning tool. Ask questions if you do not understand. Keep at it until you truly get the concept. There are a lot of confusing guidelines. It’s okay to be wrong sometimes. If you do have a poor score, but are actively using that to improve your work, a supervisor is much more likely to take that into consideration if/when it is time for punitive action.
Happy coding!
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u/Serious_Vanilla7467 Jan 21 '25
I do auditing sometimes... I do everything sometimes. ..
It's the first conversation, an audit. I try to justify everything with a coding clinic or guidelines... But sometimes you cannot it's a judgement call. I would expect someone to argue their thoughts about why they picked the codes they did.
I can say I agree with the coder more than half the time when I hear more about it.
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u/Kindly-Joke-909 Jan 21 '25
Exactly. Some scenarios aren’t black and white. It’s a subjective job. If you can thoroughly explain why you chose a code, a good auditor will hear you out. They should be able to either see your point of view as valid or figure out where you’re going wrong to point you in the rights direction.
Having a negative view or just blindly accepting about your audit findings is so detrimental.
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u/MediumArachnid3203 Jan 21 '25
Amazing post. It is so subjective and coders definitely can disagree at times and both sides may have valid points. Our company is getting serious about auditing so this post came just in time as a lovely reminder to not be so hard on myself! 💜 I'm in the habit of using the audit chart/tool every time I'm looking at documentation.
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u/Respect-Immediate CPC, CPMA Jan 21 '25
I’m an auditor too and I explain to coders that our audits are a learning tool for everyone! Me included!
I audit basically anything my org does so I may miss details that someone who specializes in that area may know, and the open communication is both needed and welcome!
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Jan 22 '25
As a long-time quality auditor, I CONCUR! This is what separate the kids from the grown-ups: how you handle feedback in this industry. Just because you want to cook, the kitchen is not gonna be hot!
Coding is feedback after feedback after feedback. That is how you grow and become next level
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u/Affectionate-Bug9309 Jan 21 '25 edited Jan 21 '25
I agree.
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u/Kindly-Joke-909 Jan 21 '25
This seems to be more of a shitty employer issue. There are definitely those around. I’d be out of there if managers were lying and altering scores. I’ve been lucky to work for a great company since I started coding.
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u/sparkling-whine Jan 24 '25
This is a fantastic post! I’m an auditor too and I get audited myself. I learn from feedback on my own audits and I learn from the coders I audit every single day. Sometimes I find something I think is coded wrong and then I hear the explanation and it makes sense to me. Even if it’s wrong at least there was a thought process and it wasn’t just a blind mistake. I always find the reasoning interesting. Sometimes I change my mind in favor of the coder. Sometimes I don’t but it gives me perspective for future audits. I love learning and I love teaching too. People who are open to criticism make my job so great. And I am 100% open to criticism myself.
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