The Role of Focused Audits in The QPP (Quality Payment Program)

The coding process in physician practices is changing rapidly as healthcare moves toward value-based care and quality payment models. ICD-10 coding plays a key role in determining payments under QPP. This marks a big shift for medical practice coders who traditionally have focused on CPT codes to drive revenue.

Providers will be out of their comfort zone with the shift to ICD-10 coding specificity so practices must prepare focused audits to identify education needs. Accurate ICD-10 coding will lead to accurate hierarchical condition categories (HCCs). The QPP programs, which include MIPS and APM paths, rely on HCCs as a factor in the risk adjustment methodology.

Focused coding audits can provide the education and documentation improvement support that providers will need in the new value based world. The audits prepare providers through education that improves their CPT code selection and diagnosis specificity. Audits review both claim level detail and the medical record documentation allowing the auditor to reconcile elements that should be present in both.

Our coding audits include one on one provider coding education. Click here for more information.