Client: Department of Defense/Health Affairs, Military Health System (MHS) Challenge: The data that MHS relies on to manage its activities is only as good as the coding that documents healthcare encounters. The coding system is complex – and the coders are only human. Solution: A CSC team performed regular audits in which certified auditors reviewed medical records and evaluated the codes assigned by MHS for accuracy and completeness. We also recommended changes in policy or technical procedures to improve coding accuracy. Results: Feedback provided by CSC’s audits helped TMA improve performance in many areas. The CSC audit approach was so successful that it was incorporated into TMA’s official guidance for coding MHS medical records. For More Information Learn about other CSC health services for government. Learn more about CSC's work for government. Contact us and let our experience help you produce results.

From well-child visits to complex cancer care, virtually every healthcare encounter in the United States is documented with codes that reflect the type and amount of care provided. The codes are part of nationally recognized coding systems and have many uses. For example, they enable accurate billing to insurance companies, Medicare and Medicaid. They also are important in analyzing medical data to help providers quantify workload requirements; to identify potential areas of fraud, waste, and abuse; and to spot potential problems in quality of care. The accuracy of coding is critical to a well-functioning healthcare system.

Making Sure It's Right
For more than five years, a team headed by CSC provided medical coding audits and analysis for TRICARE Management Activity (TMA), the health plan for the Military Health System (MHS). Our work helped TMA ensure that data in its health information systems were correct, timely, accurate and complete.

CSC’s team included certified medical coding auditors. These highly experienced experts understand not only commercial coding practices, but the unique coding requirements of the MHS as well. The auditors reviewed encounters documented in medical records and evaluated the codes assigned by MHS for accuracy and completeness. Findings from coding audits provided valuable feedback to the government regarding the accuracy and precision of DoD’s medical data.

CSC also worked to improve the quality of data initially entered into military health systems. We trained coders to improve their performance, and we recommended technical and policy changes that were likely to raise the quality of medical record coding by TMA, military service branches and others.

Government Adopted CSC Processes
Over many years of supporting TMA, CSC’s highly nuanced understanding of TMA’s coding audit requirements fostered a uniquely collaborative working relationship that enhanced TMA’s business processes. Our systematic, repeatable, and efficient audit process allowed ongoing monitoring and improved resource utilization. The CSC audit approach was refined so well and accepted so completely that it was incorporated into TMA’s official guidance for coding MHS medical records.