Auditing and documentation are important for healthcare organizations to ensure accurate billing and reimbursement. The document discusses 5 reasons why audits are more important than ever: 1) They enhance data quality which leads to better reporting and research opportunities. 2) They increase operational efficiency by automating manual tasks and detecting errors. 3) They improve patient safety by finding errors and giving real-time feedback. 4) They improve relations between healthcare providers and HIM staff by providing feedback. 5) They enhance reimbursement accuracy by ensuring proper documentation of patient complications. The document also discusses how one hospital improved coding efficiency, decreased discharge times, and saved $1 million by implementing an AI-powered auditing solution.

1. https://www.ezdi.com/
5 Reasons Why Coding and Documentation
Audits are More Important than Ever

2. • Auditing is an integral aspect of governance and quality management
for organizations across industries. Many healthcare organizations
adopted new electronic health record (EHR) technology with the
implementation of ICD-10 (International Classification of Disease, 10th
version).
• It outlined unprecedented detail in record-keeping, with over 71,000
procedure codes from just over 3,800 in the previous ICD-9. In order
to make the most of a system as intricate as this, healthcare providers
would do well to adopt solutions driven by technologies powered by
natural language processing (NLP) and artificial intelligence (AI). This
would lead to fewer errors in data and billing, and thereby fewer
payment lapses.

3. • Medical coding audits seek findings that support the
implementation and enhancement of clinical documentation
improvement (CDI). Auditing CDI teams can optimize diagnosis-
related groups (DRGs) as well as retain and hire the right staff that
can maximize revenue.
• Initiatives such as the Recovery Audit Contractor (RAC) program by
the Centers for Medicare and Medicaid Services (CMS) have proven
the need for effective CDI by recovering millions in improper
payments in Medicare and other insurance schemes.
The Growing Need for Audits

4. Here are five reasons why audits are more important than ever:
Enhanced Data Quality:
Reliable data is a cornerstone of healthcare. The right compliance auditing
program, along with informed stakeholders, a rigorous feedback loop, and
consistent follow ups, significantly increases the quality of data.
This leads to better reporting and research, making it easier for healthcare
organizations to win funds or grants.

5. • Higher Operational Efficiency: Manual medical coding and billing is a
big challenge for providers everywhere. Each manual transaction
costs $4.40 more than each automated transaction, according to the
2018 CAQH Index Report. The same report states that automating
claims-related dealings can save healthcare providers around $11.1
billion yearly, yet the industry has made modest progress in
transitioning from manual to fully automated transactions.
• Automated auditing can detect various errors and also shine a light
on the root causes of coding and documentation discrepancies. This
can even improve employee morale and productivity if seen as
complementing their work instead of supplanting it.

6. • Improved Patient Safety: According to an article in the
International Journal for Quality in Health Care, internal
auditing decreased patient-related adverse events by 4.8%.
• With timely detection of errors and instant feedback to medical
personnel, real-time auditing can enhance patient safety.
• Changes in clinical policy and practice can be ushered in with
confidence, since auditing will pinpoint the areas where lapses
exist.

7. Improved HIM-Physician Relations: Properly executed audits by health
information management (HIM) staff will root out documentation errors
induced by all involved parties, including physicians.
With correct practices in place, these two primary stakeholders in patient care
gain a better understanding of how their own work processes affect the other.
Physicians who frequently make errors in documentation can work with HIM
personnel to learn more about the right practices. Regular feedback and
increased transparency will ensure better quality work.

8. Enhanced Accuracy of Reimbursements: Underpayments and overpayments have
plagued hospitals and care centers for a long time. According to a CMS
report submitted to the U.S. Congress, RACs recovered $214.09 million during the
2016 fiscal year.
Correct auditing practices will ensure proper documentation of complications and
comorbidities (CCs) and their major variants (MCCs). The seriousness of any illness
is, of course, decided by the presence or absence of CCs and MCCs, which
determines payment for hospital services. In short, correct auditing can recognize
these lapses in billing processes and ensure that both organizations and patients
get the reimbursements due to them.

9. In 2016, Auburn Community Hospital (ACH), a not-for-profit acute care facility in
Syracuse, New York, experienced difficulties with their encoder software while
completing their coding and CDI-related work. Their discharge not final coded
(DNFC) was seven days and they had a case mix index (CMI) of 1.2024.
ACH needed to eliminate coding backlogs, assign accurate ICD-10 procedure codes,
and improve coder efficiency. The facility needed customized worklists and an
intelligent platform that could track missing documents and recognize opportunities
for CDI. Their DNFC and CMI needed immediate improvement as well.
Case in Point: a Syracuse Hospital
Halves DNFC and Saves $1 Million

10. At ezDI, we believe healthcare organizations need to adopt the right NLP-
based auditing application. Such an application can automate manual
processes, enforce smart wordlist prioritization, auto-generate evidence-
based queries, and more, all on a collaborative single platform.
These were the benefits we were able to provide ACH when the hospital
decided to leverage ezDI’s NLP-based technologies. This included the
computer-assisted coding (CAC) application, ezCAC, a fully integrated
encoder, ezEncoder, and ezAssess, ezDI’s coding compliance software.

11. Our applications went live at ACH and, in the course of a year, the
organization experienced:
4.59% increase in CMI by improvement of the complication/major
complication (CC/MCC) capture rate, resulting in optimized DRGs
50% decrease in DNFC days from the initial 7 days to 3.5 days, leading to
greater cash-on-hand

12. Over 40% improvement in coder efficiency by the provision of
automated code suggestions to coders
Elimination of all IT support through our cloud-based technology
ezDI helped ACH better their revenue cycle process, where the
bottom-line impact after a year was $1 million.

13. It is imperative for healthcare organizations to adopt rigorous auditing
practices that promote employee performance and organizational
transparency. While AI-based NLP auditing tools have become more popular,
only organizations that choose the right vendor-cum-partner will witness a
robust return on investment (ROI).
ezDI can assist your organization to improve patient outcomes and revamp
your healthcare processes for the future.
To know more, subscribe to our blog and to request a live demo, contact our
experts.
Achieving New Heights with AI and
NLP

14. Contact us
Visit Our Website:- https://www.ezdi.com/
Phone no:- (866) 473-5655
Address:- 12806 Townepark Way, Louisville, Kentucky 40243