Medical Coding Education

What Auditors Look for in Risk Adjustment Documentation Risk adjustment audits focus heavily on documentation accuracy, clarity, and clinical support. Even when diagnoses are coded correctly, insufficient documentation can lead to recoupments, data inaccuracies, and compliance risk. Understanding what auditors prioritize helps coders recognize documentation gaps and support defensible code assignment. The Role of Documentation […]

Provider queries are a critical part of compliant medical coding, yet they are often misunderstood or inconsistently applied. Knowing when to query—and when not to—protects data integrity, reduces audit risk, and supports accurate code assignment. This article outlines best practices for identifying appropriate query situations while maintaining compliance and professional standards. Understanding the Purpose of

Introduction Risk adjustment coding plays a critical role in accurately reflecting patient complexity and supporting appropriate reimbursement. Errors in Hierarchical Condition Category (HCC) capture can result in under-reporting risk, audit findings, or compliance concerns.Understanding common HCC capture errors helps coders improve accuracy while maintaining compliance with documentation standards. Why Accurate HCC Capture Matters HCC coding

Introduction Accurate ICD-10 coding depends heavily on clear, complete provider documentation. Inadequate or vague documentation is one of the most common causes of audit findings, claim denials, and compliance risk.The following documentation tips can help reduce audit exposure while supporting accurate code assignment. Why Documentation Matters for ICD-10 ICD-10-CM requires a high level of specificity

Introduction Medical coding accuracy is critical to compliance, reimbursement integrity, and overall healthcare operations. Even small documentation or coding errors can lead to claim denials, audit findings, and compliance risk. Below are some of the most common medical coding mistakes — along with practical strategies to avoid them. Mistake #1: Coding Diagnoses Without Sufficient Documentation