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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?

Jaci Kipreos

About Has 8 Posts

Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC, has been in the field of medical coding and auditing for over 30 years and received a Bachelor of Science degree in finance from Virginia Tech. She has worked in a variety of practice settings and has expertise in coding for family practice, urgent care, obstetrics and gynecology, general surgery, and Medicare’s teaching physician guidelines, with an emphasis on compliance with evaluation and management guidelines. Kipreos has been an instructor for various AAPC workshops for the past 10 years and is a frequent speaker at AAPC’s national and regional HEALTHCON conferences. She has also provided presentations for the American Association of Nurse Practitioners state event in Virginia and the national event for the American Association of Medical Assistants. Kipreos is a past president of the Richmond, Virginia and Charlottesville, Virginia local chapters, and served as president of AAPC’s National Advisory Board from 2015 to 2018.

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