What’s the Use?

What’s the Use?

The question is not intended to mean there is no use to perform an audit; but it is to question who will use the results or findings.

The format for presenting the findings is often based on who will be evaluating the results. If we know the use, we can determine how much detail to provide to explain the variances, as well as know how much quantitative information to provide (vs. a lot of qualitative perspectives).

Sometimes, when the audit is being performed per the request of the administrator, it is unknown if the provider knows there is an audit taking place. And what about the audit request from the administrator who tells you in advance that he or she is anticipating that the provider will “fail” an audit—and in fact would prefer that the provider did, so a lesson can be learned? Is the use of an audit punishment? Will the audit not be useful if the provider does not fail?

If you are acting as an IRO and the findings are being used as part of an OIG follow-up audit, the results will determine the fate of a provider; do we then let any of that affect the audit findings? When the use is this important, how do we handle those gray areas of E/M coding? Do we always err on the side of being conservative, as the results carry such a heavy weight?

When we know the findings are truly to be used by the provider for education, do we alter the format to make the results more concise? Do we provide more direct information that is quick and easy to evaluate and digest?

When the audit findings are to be used for education, do we find it easier to give a little on the gray areas. Do we find it easy to agree to disagree? Perhaps we want to meet with the provider to explain the risk areas, versus simply making a comment that something is “wrong.”

These are fair questions.What is an auditor to do? As auditors, we can only answer them for ourselves. Perhaps your audit will look the same and be the same, no matter who will be reading it or evaluating the findings. It is your call, not mine… I have my answers. But really? What’s the use?

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Jaci Kipreos

Jaci Kipreos

Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of AAPC’s National Advisory Board, has been working in the field of medical coding and auditing for over 28 years and has been a CPC® since 1994. She teaches PMCC and manages a national client list, providing compliance monitoring for provider documentation. Kipreos was recognized as Coder of the Year in 2006 for the state of Virginia. She has served office as president for the Richmond and Charlottesville, Virginia, local chapters. Kipreos received her Bachelor of Science in finance from Virginia Tech.
Jaci Kipreos

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Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of AAPC’s National Advisory Board, has been working in the field of medical coding and auditing for over 28 years and has been a CPC® since 1994. She teaches PMCC and manages a national client list, providing compliance monitoring for provider documentation. Kipreos was recognized as Coder of the Year in 2006 for the state of Virginia. She has served office as president for the Richmond and Charlottesville, Virginia, local chapters. Kipreos received her Bachelor of Science in finance from Virginia Tech.

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