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Relay Your Compliance Report to the Right Audience

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  • October 1, 2013
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Part 2: Effectively communicate audit results to the overseeing physician, committee, or board.

A medical records audit is a crucial element of any audit and compliance plan. Equally important is who reviews the audit report. Last month, in Part 1 (“Report Audit Results to Educate”) of this two-part series, we talked about the importance of relaying audit results to the physician or non-physician practitioner. It is also essential that you report back to the overseeing physician, committee, or board. As shown in Table A, the size and type of the practice typically determines who should review the results of an audit.

What to Reveal

The one constant when reporting results up to the compliance level is what information will be conveyed in your reports. You don’t need the detail level you give the individual provider for education purposes, but you do need to report on the outliers and provide a general overview of how the practice is performing as a whole.
Keep in mind: Reporting periods may vary depending on the size of the practice. A single specialty or smaller group specialty practice (two to 25 providers) may only meet quarterly, while a large group practice or teaching institution may meet on a monthly basis.
Let’s start with the basics of what you need to convey for the reporting period:

  • Number of providers reviewed
  • Total number of medical records reviewed
  • Number of providers who passed review
  • Number of providers who did not pass review

There are several ways to present this basic information. A pie chart, bar graph, or similar graphic can quickly convey the pass/no pass rate at a glance. A spreadsheet, however, might be more appealing to the more analytical compliance officer. Whichever format you use, make sure to include all the information noted above.
Examples 1, 2, and 3 show different ways of reporting general pass/fail results. Example 1 is a bar graph that shows the actual number of providers who passed or failed in each of the bars; C=150 indicates the number of charts was 150 (or 10 per provider). Example 2 is a bar graph that shows how you can report by percentages instead of by the number of physicians. Example 3 is a simple Microsoft Excel spreadsheet you can distribute as is, or paste into a Microsoft PowerPoint presentation.
Every compliance officer or committee member will have a preference for how he or she would like to review this information. Find out what it is and use it.

Show and Then Tell

After you present this basic information, drill down a little to uncover some specifics. Definitely present the physicians with a high passing rate. This will show the providers who are meeting the benchmark for chart audits. If you have multiple specialties in your group, you may also show pass rates by department or specialty.
When you drill down to this level, a compliance officer or committee will want to know:

  • Providers who met the benchmark for the pass rate
  • Providers who did not meet the pass rate benchmark

This is the part of the presentation where you may be asked to provide specific provider names and departments for those who did or didn’t meet the benchmark determined by the practice. If you’re auditing a large group practice or teaching facility with 300 or more providers, you do not have to include the entire list of providers who were audited—the major standouts (i.e., the providers who met or exceeded the pass rate and the lowest scoring providers) will suffice.
Tip: Rather than create a special report for this information, simply make sure to have the individual provider results at your disposal.
The information shown in Examples 4 and 5 is the same: the pass/fail rate based on a benchmark. Example 4 is a bar graph and Example 5 is a line graph. Both chart formats offer a better visual image than a spreadsheet with numbers. Just make sure the benchmark is noted on the graph you choose.

Get Down to the Nitty-gritty

The next step when reporting to a compliance officer or committee involves showing historic information. Compliance plans are based on annual audits, re-audits, and education of providers. This information must also be passed onto the compliance officer or committee:

  • Detail of no pass results
  • Over-coding issues
  • Under-coding issues
  • Wrong code category
  • Education provided
  • Tools or other interventions
  • Scheduled re-audit date following education/intervention

This detailed information is multi-purposeful: It can show improvement in documentation from a provider or group of providers. It can indicate what factors have helped in improving documentation and pass rates. It also can reveal which providers have not improved or haven’t received education. Provide a summary of this information so you don’t bog down the report with too much detail.

Make It a Learning Experience

The information you include in your report may differ not only by practice size, but also by the education type or interventions used to improve results. For example, you might create and present a report that shows improvement in audit results, and what events might have led to those improvements.
Example 6 shows details based on how many records were over-coded, under-coded, the wrong category, etc. It’s a simple format that contains information on all of the providers audited in the reporting period.
For example, let’s say you have a provider who has consistently rated below the benchmark and has been educated. The provider typically is off the bell curve and has handwritten notes. When meeting with coding staff, the provider acknowledges he does not have time to write down all of the information and agrees some documentation may be illegible. The coding staff begins to work with the provider to create a template that captures documentation in support of the correct level of service necessary for the patient’s condition.
Example 7 shows the provider’s audit results, and then a spike in his or her pass rate. A notation is made to show the creation of the template that aided the documentation process.
The last step is reporting education and re-audits. The best way to do this is to compile a simple spreadsheet. Example 8 shows how you can convey who received education, what was covered, and when you plan to follow up or re-audit.
After determining a practice’s preferred reporting method, create a template or other mechanism that will allow you to convey future reports in a consistent and efficient manner.

Certified Professional Medical Auditor

Brenda Chidester-Palmer, CPC, CPC-I, CCS-P, has 18 years of coding and billing experience. She is the principal of Palmer Coding Consultants. Chidester-Palmer is former coding compliance manager for Kelsey-Seybold, a large group practice in Houston. She is an approved PMCC instructor, AAPC workshop presenter, past president of the Tyler, Texas, local chapter, and previously served on the AAPC National Advisory Board. Chidester-Palmer also presented at AAPC National Conferences in Long Beach, Calif., Jacksonville, Fla., and Las Vegas.
John Verhovshek
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About Has 577 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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