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Why Chart Audits?


Identify documentation errors preventing appropriate coding ... how many HCCs will an endocrinologist really see in the chart compared to a PCP? ... – PowerPoint PPT presentation

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Title: Why Chart Audits?

Why Chart Audits?
Presented by Pam Leal
Chart Audit Strategy
  • Initiatives
  • Finding Conditions Documented in the Chart but
    not coded
  • Identify documentation errors preventing
    appropriate coding
  • Identify chronic recurrent conditions not being
    coded in subsequent periods (Old MI,
  • Outcomes
  • Revenue Recovery
  • Provider Feedback
  • Reminders to assess and document chronic

Chart Audit Approach
  • Use of Vendors
  • experts (certified coders, nurses, physicians)
  • flexible resources - can tackle the masses
  • Date Range to Audit
  • keep CMS sweeps in mind currently 2004 2005
  • Pilot - Nevada
  • IPA setting, capitated for professional, and
    delegated for claims payment
  • PCP Audit yielded 8 times the investment
  • Specialist Audit yielded 2.6 times the investment

Chart Audit Approach
  • 100 of Charts vs. Targeted
  • Targeted based on enhanced data mining strategy
    (Prevalence Reports) most likely to find HCC
  • Using targeted data results in auditing about 25
    of all charts
  • What to Audit
  • Once chart is pulled, report ALL existing
    conditions, not just the one that identified the
    chart as a suspect
  • PCPs vs. Specialists
  • ROI on Specialist records is about 2 times the
  • PCPs evaluate a broader spectrum of codes (
    HCCs) than Specialists how many HCCs will an
    endocrinologist really see in the chart compared
    to a PCP?

Chart Audit ROI
  • ROI using Data Mining to Target Suspect Charts
  • California Range from 15 times to 37 times the
  • California Average 25 times the investment
  • Example one IPA conducted audits looking only
    for the diagnosis codes targeted by reporting -
    Vendor audited the targeted charts, noting all of
    the diagnosis codes documented, and the NEW ROI
    was still 33 times the cost of the audit.
  • ROI when Auditing 100 of Charts
  • California Range from 8 times to 18.6 times the
  • California Average 10.5 times the investment

Chart Audit Metrics
  • 10 of charts reviewed have unreported HCCs
  • Average RAF increase per chart with at least one
    finding .374

What is the Potential?
  • Colorado chart audits revealed findings in 12 of
    charts reviewed and provided a 9 to 1 return on
    chart audit expense.

Post Chart Audit Activity
  • Feedback Reports by Physician
  • Feedback Reports by Patient
  • Problem List for Patient Charts
  • Physician Education
  • Follow-up with Monitoring

Feedback Report Phys Summary
Feedback Report Member Level
Problem List
Education Follow-up
  • Post Chart Audit Education Follow Through
  • for Physicians - review physician summaries and
    identify potential causes / issues
  • for Office Staff
  • Problem List Report, by member, includes ALL
  • Review Existing Superbill for Potential Causes
  • consider changing superbill to provide a more
    defined set of codes
  • consider other support tools / job aids to assist
    in the selection of the proper code in difficult
    or common situations

  • Define Issues
  • Design a Monitoring Process
  • Incorporate into regular activities not just a
    one-time chart audit and one time follow up
  • Identify continued compliance with Best Practices
  • Track progress with identified measures
  • i.e. Signing ALL Progress notes?, using multiple
    diagnosis codes per claim, using the CORRECT
    diagnosis code at the highest level of
    specificity, evaluating all chronic conditions at
    least annually.
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