2027 Auditors` Desk Reference

• Optum Edge — Get online access to customizable audit worksheets. Protect your revenue-critical services and procedures. 
• Conduct skilled internal audits. Know what information needs to be in the medical record and correct code assignment for ICD-10-CM and CPT® codes on the claim form to capture appropriate reimbursement. 
• Differentiate between similar procedures. Compare and contrast seemingly similar, but different, procedures. 
• Correct modifier assignment. Modifier decision-making trees assist with assigning correct modifiers.
• Provides coders with an auditor’s perspective. Know the clinical details, regulatory instructions, and coding best practices needed for code assignment. 
• Key terms. Identify terms that need to be mentioned in the medical record to support code assignment. 
• See the medical conditions that are indicated for diagnostic, therapeutic, and surgical purposes. 
• Train your staff. This resource is thorough and can easily be used to train staff on how to assign codes appropriately. 
  
  

Tara Rose has more than 20 years of experience in the health care profession. She has extensive experience in auditing, physician billing, and multi-specialty coding with assignment of CPT, HCPCS, and ICD-10-CM codes. She has served in roles as a coding consultant, trainer, clinical investigator, community college instructor, and coding lead. She has experience providing education to physicians and both new and experienced coders. Tara is a member of her local AAPC chapter and holds credentials from the American Health Information Management Association (AHIMA).

Victoria Shishkina has more than 10 years of experience in health care, possessing expertise in CPT, HCPCS, ICD 10- CM, and PCS. She has built a proven track record in analyzing, auditing, and resolving complex professional and outpatient facility claims, ensuring compliance with billing standards and regulations. In the past, she served as a clinical medical auditor, medical coder and biller, and was actively involved in professional development, having served as Vice President of the AAPC local chapter. She holds an MBA in Healthcare Management from Capella University.