Their reviews aligned 89% of the time and identified only 46% of claims with issues, half of which were related to medical necessity, not coding errors. “These audits are very intricate work that take ...

ASCs should incorporate an external audit into their compliance programs. Formal coding audit protocol should define the purpose of the audit, frequency of review and sample size. The difficult part ...

Coding experts agree that ASCs should conduct regular audits of their coding processes to ensure the ASC is not upcoding, a possible fraud issue, or downcoding, leading to a loss of owed reimbursement ...

Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...