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Spring 2022

Editor’s Note: The Pandemic Heightens Auditing’s Value
By Lee DeOrio
For The Record
Vol. 34 No. 2 P. 4

Not much good has come from COVID-19’s arrival. Its effects will linger forever. The onslaught of the pandemic has been an eye-opener for the health care industry, knocking it to its knees but never down for the count. Countless heroes stood up against COVID-19 and continue to do so as a measure of relief has descended on a beleaguered work force.

Nevertheless, the nation’s health care system will never be the same—and that’s not necessarily a bad thing. We’ve discovered just how immense are the disparities that fester and threaten to destroy lives. Then there’s the matter of hospital finances, which have always been precarious, but never has that fact been more pronounced than during the pandemic. For months, it seemed as though closures were being announced daily.

In this environment where margins continue to shrink for many health systems, the role of internal auditing has assumed even greater importance. While nearly all providers document and code accurately, most still have areas where gaps can be closed to ensure appropriate reimbursement is being received.

“Coding audits have always been a tool through which a facility could validate correct coding or to reveal where there may be inaccuracy in the coding arena,” says April Smith, CCS, HIM client services manager at JTS Health Partners. “Audits have been historically used solely to conclude whether or not the facility is losing revenue.”

As vaccines were fast-tracked and COVID-19 conditions became better understood, health care organizations needed codes to capture what was happening on the front lines.

“As the pandemic evolved and as more ICD-10-CM and ICD-10-PCS codes were created to capture accurate reporting of both diagnoses and procedures involving COVID-19, we have relearned the critical importance of accurate coding necessary for statistical reporting purposes, not only financial issues,” Smith says.

New codes and decision-making processes also meant auditors needed to step up. It can be argued that accurate data have never been more important. Otherwise, the effects of the pandemic won’t be as thoroughly documented. “Auditors have become, and will need to remain, more vigilant as coders work to capture ongoing infections and the long-lasting effects of COVID-19,” Smith says. “An auditor’s insight postaudit will reveal areas of needed education as coders work to adequately report these conditions and their treatments. Aggressive auditing will ultimately ensure accurate coding not only for revenue purposes but also as we report these critical health statistics going forward.”