Wiki Audit programs

[Michele Fecho]

We are looking to revise our audit program & I was looking for your input. Would you be willing to share what your program is? Currently we audit about 350 providers every quarter. We do 2% of their volume for a minimum of 10 charts & a maximum of 25. We were doing retrospective & switched to prospective. (but are probably going back to already billed claims) We were trying to use WQs set up in EPIC to drop all claims in order to select charts for audit. Finance doesn't like holding claims & it is time consuming for staff to go thru these WQs to choose what is needed & manually release the others. Physicians don't think it's random since the 10-25 charts chosen aren't selected over the 3 month period. We have 9 coders/auditors but 4 of them do surgical procedures & only a limited amount of audits. Our audit rate ranges from 4 to 8 charts per hour depending on experience. We use a scorecard rather than percentage to determine result. We recently had a consultant tell us that we are not auditing enough. Thanks

 

[JPisca]

My rule of thumb is to audit 10% of physician charts, but depending on the final scorecard results, your 2% might be just fine, unless issues are found.