Your department doesn’t have to code anything wrong to feel the beginnings of a peptic ulcer as soon as someone announces that there’s going to be a coding audit. The department members are doing their job, of course, no matter who decides there should be an audit. They make sure there’s no low-hanging fruit or money being left on the table—or whatever the newest buzz phrase is that week.
Let’s look at what that really means, however, to the department’s daily process. The impact on staff (and their reputations) depends on several conditions.
How Many Charts Will Be Audited?
The very first task is to identify and pull all the charts. In the event that the auditor already knows which charts it wants pulled, you can skip this part. Payors usually have a specific group of charts they have identified as being in their target population for review. Medicaid may lean toward specific patients such as moms and babies with higher-paying diagnosis-related groups (DRGs) but a short length of stay. Medicare is more likely to focus on DRGs with a high percentage of complications/comorbidities (CCs), one-day stays no matter what the DRG, or certain ambulatory payment categories (APCs) such as those for chest pain and asthma.
How many charts will be included in the audit will determine how many additional hours you will need to budget for the effort. Remember that you will need to figure time for looking up location, retrieving the charts, then identifying and holding them until the audit is complete. Don’t forget to calculate time to reretrieve any that are pulled in the middle for patient care or physician review and to return them all to file after the auditors have finished. Don’t return them too fast or you’ll be digging them back out for your own reviewers to validate or refute any concerns identified by the initial group of chart detectives.
Whose responsibility is it to pay for the additional hours? Do they intend to send internal reviewers or do you have to copy charts and mail them to the auditor? Negotiate that on the front end if you get the opportunity.
How Computer-Assisted Coding can help in an Audit?
How do you deal with audits at your facility. I know we had hybrid charts that mainly reside with paper. Our Codes are printed on a face sheet that is attached to the chart which was a nightmare. Now when we have audits there is no panic there are no peptic ulcers. We now use a computer-assisted coding program to help track our audits. Since most of the chart even if you do have an entire paper record it can be processed by the CAC program and this creates hyperlinks to the codes making auditing a breeze. If you need more info about it let me know. I can share our story…
