Today's Webinar-Salary Survey

This section of our forum is dedicated to those with questions regarding the industry standards in salary expectations, job duties and requirements, and also allows for those interested in obtaining a position in auditing or compliance to post as well. If posting about a position, we encourage individuals to use a social account such as LinkedIn for conversational and self promoting purposes and to be mindful of posting certain personal information in this forum- or online in any format.

Moderators: NAMAS Moderator, Shannon DeConda

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Posts: 47
Joined: Fri Aug 03, 2012 10:22 am

Tue Apr 07, 2015 4:04 pm

Hi, Shannon,
Thank you for presenting that data today. It was very interesting. In response to a topic you raised in the presentation, I have reservations about staff with little-to-no coding experience being placed in auditing positions. My personal perspective is that one should serve in a coding role for a significant amount of time before being placed in an auditing role. Credibility with providers and other staff can be lost and rapport seriously damaged if this occurs, and I believe we owe our providers and other staff much more than that. The staff member suffers as well if they are not at a skill level suited for an auditing position. No matter what classes a person has taken or what credentials they may have acquired, I believe it still takes experience in coding to develop a good working knowledge base and to learn just how expansive and varying the interpretations of the guidelines can be, prior to moving into an auditing role, which I view as a next-level position. They also must learn how to communicate guidelines and opportunities for improvement in a way to which providers and others will be receptive and not take a defensive stance. To me, a big benefit of real-life coding experience is to find out you don't know everything, you can't possibly ever know everything, but for many-to-most issues, you at least know where to find the authoritative resources and can discern authoritative guidance from coding myths, opinions, etc.
Shannon DeConda
Global Moderator
Posts: 53
Joined: Thu Apr 12, 2012 2:53 pm
Location: Melbourne, FL

Wed Apr 08, 2015 12:02 pm

I am glad that you were able to login into the presentation and that you found the information useful.
Regarding auditors and years of experience-- I work with fraud investigators and SIU and I understand the need for fraud prevention and if you think about it as an auditor that is exactly what the job is making sure in day-to-day operations that practices are operating in a compliant manner. However, if auditors who are making decisions about billing/coding/documentation appropriateness are not trained in these areas- we end up spending WAY too much money on both sides of the fence-- with creating the investigations and carrying it out, then the provider working through the findings and forming an appeal and then back to the carrier for reconsideration, and so on it goes up the ladder potentially to a hearing-- all the while the original audit could have taken place by an auditor or investigator that while they are brilliantly educated as an RN, or in business, or some areas of health law, and potentially even law enforcement, are lacking in medical auditing experience and have cost everyone significant dollars.

For me it's not a matter of the carriers are wrong and the providers are right-- NOR is it about the carriers are right and the providers are wrong-- it's about the operations people doing a job that they are experts at and testing in proficiency to ensure that if any auditor is "passing judgment" on a providers work and holding them to a certain precision rating-- should meet the same expectations.

Ok, climbing down from my soap box now. haha!
Thank you,
Founder & President of NAMAS

Disclaimer: NAMAS cannot be held liable for any advice given that could have had a variable answer based on additional information.
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