Compliance Risks in ICD-10-CM Coding for 2020: Critical Audit Red Flags

Understand the state of healthcare and ICD-10-CM clinical coding compliance and “Red Flags”, per the OIG, CERT, PEPPER and RAC targets

Accuracy and integrity of clinical coding is a day to day challenging goal. For coding professionals knowing the regulatory targets and red flags (warnings) is critical in order to meet and achieve compliance. The Office of the Inspector General (OIG) has published reports that provide the warning signs: https://oig.hhs.gov/
The Recovery Audit Contractors have a long list of ICD-10-CM coding areas they are targeting and auditing: https://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Index

Healthcare has many regulatory bodies watching over the coding and billing. Identifying the “risks and red flags” in clinical coding can greatly help with correction and prevention. In addition, the clinical documentation and EHR risk areas that create compliance gaps and vulnerabilities need to be clearly understood and addressed. ICD-10-CM codes that generate CC/MCC and HCCs can be an area of risk unless you have a strong audit and education plan in place.

Join the renowned coding and compliance expert, Gloryanne Bryant, to be prepared and follow ethical coding standards that assist in achieving coding accuracy for both inpatient and outpatient coding. Compliance Risks and vulnerabilities can lead to investigations and fines. Improper reimbursement (payments) can occur without a strong understanding of the risks in clinical coding.  

Session Objective

• A Review of the PEPPER, CERT, OIG and RAC coding compliance risks


• Provide information on where to obtain details on coding compliance risks and red flags


• Understand the key steps and strategies to diminish compliance gaps and vulnerabilities


• Walk through some case scenario’s and learn about key action to take to improve coding accuracy and compliance.


• Address ICD-10-CM coding compliance questions and best practices


• Discuss next steps (identification, correction and prevention) and ways to be complaint and being ethical.


• Action to take

Session Agenda

• Knowing the coding compliance risk areas is essential to Coding and CDI Professionals but sometimes difficult to identify and be aware of.


• Avoiding regulatory scrutiny for clinical coding is a must today!


• Ethics and compliance are part of the foundation of a clinical coding and CDI professional.


• Coding auditors and educators can improve their work by having a clear understanding of the ICD-10-CM coding compliance risks, vulnerabilities and “red flags”.


• Doing the “right thing” is always what is right to do, this is true for coding compliance as well.

Who Should Attend

• Clinical Coding Staff, Supervisor/Manager – both hospital inpatient/outpatient, physician office, etc.


• Coding Auditor


• Coding Educator


• Coder/Coding Professional


• Coding Compliance Specialist/Mgr.


• Clinical Documentation Improvement specialists


• Hospital ER coding professional


• Physician Office Coding Staff


• LTC and Rehab Coding Staff

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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