Coding Audit definition

Coding Audit means: (i) [*****], random sample-based quality assurance audits, conducted by or on behalf of Supplier, of the accuracy of the billing coding performed by Supplier coder. As part of this [*****], random sample-based audit, each Supplier coder shall be audited. (ii) [*****], random sample-based quality assurance external audits, performed for Ascension Health, whether engaged by Ascension Health or Supplier. 1. With respect to each of the [*****], an external auditor will be engaged to conduct a random, sample-based audit of the [*****] audits referenced in (a) above. The purpose of this [*****], [*****], will be to confirm Supplier’s [*****] coder audits meet expectations. Supplier shall engage such auditor for [*****] and Ascension Health shall engage such auditor for [*****]. After [*****], the Parties shall reevaluate the scope and structure of any annual, random sample-based quality assurance external audits to be performed on a prospective basis. 2. For clarification, [*****], random sample-based audits will be deemed separate and distinct from the Parties’ individual or collective risk-based, focused Compliance audits, although such audits may be performed at or during the same period of time. (iii) Any auditing, including as done by external auditors, will utilize random or probability sampling commensurate with nationally-recognized audit standards and practices. (iv) Cases coded by a Transitioned Employee shall be subject to the Coding Audits only after such Transitioned Employee has been employed by Supplier for [*****]. Thereafter, Transitioned Employee Supplier coders shall be audited at [*****], consistent with the [*****] coding quality assurance audits noted in a) above. (v) In conducting the Coding Audits, Supplier shall use only personnel holding the following credentials: Auditors of inpatient coding records must have at least [*****] of hospital inpatient coding experience and auditors of outpatient coding records must have at least [*****] of hospital outpatient coding experience. Additionally, each coding auditor must have any one or more of the following credentials: (i) RHIA, (ii) RHIT, (iii) CCS, (iv) CPC, or (v) CIC.

Coding Audit means R1’s [*****] sample based internal audit of the accuracy of the billing coding performed by R1 employees, which audit shall not (for the avoidance of doubt) include billing coding performed by any third party coding services provider (whether engaged by R1 or IMH). Cases coded by a Transitioned Employee shall be subject to the Coding Audits only after such Transitioned Employee has been employed by R1 for one full [*****]. Each R1 coder shall be audited at least [*****]. In conducting the Coding Audits, R1 shall use only personnel holding the following credentials: auditors of inpatient coding records must have at least [*****] years of hospital inpatient coding experience and auditors of outpatient coding records must have at least [*****] years of hospital outpatient coding experience. Additionally, each coding auditor must have any one or more of the following coding credentials: (i) RHIA, (ii) RHIT, (iii) CCS or (iv) CPC. This Service Level measures performance with respect to the IMH Facilities.

Coding Audit means R1’s [*****] sample based internal audit of the accuracy of the billing coding performed by R1 employees, which audit shall not (for the avoidance of doubt) include billing coding performed by any third party coding services provider (whether engaged by R1 or IMH). Cases coded by a Transitioned Employee shall be subject to the Coding Audits only after such Transitioned Employee has been employed