Wiki Audit Form or Trend Form

[arkassabaum]

Hello!

I was wondering if anyone would be willing to share their internal audit or trend form. For reviews, we use ReviewMate to log, track and trend findings. However, I am looking for something internal to help teammates improve upon reporting out trends and help myself as well. Consistency and specificity are my main goals.

We also use excel to track coder opportunities and trends but its free form. I was hoping to see something more geared towards specific audit findings, to help guide reviewers.

I am happy to collaborate and share as well.

amanda.mavis@aah.org

 

[TThivierge]

Hi Arkassabaum,
I believe you could track trends by payer denial with focus on each different medical specialties or define coding rules per type of medical care
Other issues to audit of differ deficiencies coders should pick up are the following......
1.Type of denials per medical specialties of IP or OP treatment. Ins denials of pre authorization not done, payer order wrong, use of unspefic. dx, wrong dx used, missing modifiers ,or attending doc's name or time on med record, Etc)
2.Unspecified dx code used when a definitive dx or narrative telling you what should be correctly listed in documentation
3.Are chronic conditions and comorbidities coded since listed in the documentation? Are combination dx codes used properly?
4. Is there conflicting assessment or dx. with the ROS and HPI
5.Is the chief complaint missing? Is the provider describing the care and plan of treatment properly?
6.If use follow up visit should tell what illness being followed up on returned visit
7.Are any TOAD(Transplants, Ostomies, Amputations, Dialysis) mentioned patient suffering with added to coding dx list if applicable
8.Noticed any upcoding or downcoding or unbundling?
10 Proper use of Z codes which does affect sequencing if wrong (Z76, vs Z51.12 vs Z01 vs Z79,4)
11.Notice any cloning of med records or additional dx codes missed when required? Example of dx N39,F02, G31, G29)
12. Lab or x-rays ordered but not documented of their medical necessity
13. Is the proper gender of patient used in documentation , verifying if telehealth & minutes used in relation to phone or video treatments ? Hopefully no slang acronyms added either.
14.Pay attention to the Excludes 1 rule, use of laterality regarding organs and side of body, adding infection dx when lab results are positive & available
Well hope helped you somewhat
Lady T