Another audit question - accuracy rate

MnTwins29

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When performing self-audits or coding reviews, whether they are for physicians who code their own records or done by coding staff, what is typically the minimum standard? Our senior administrators want to set the standard at 100% accuracy for our clinic physicians, who must assign their own codes. I am not comfortable with 100%, only because we are only human and this leaves absolutely no room for human error. I suggested 95% because I believe I have read literature that this was the standard for certified coders. What do others use and do you have literature? Thank you for all responses!
 

btadlock1

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When performing self-audits or coding reviews, whether they are for physicians who code their own records or done by coding staff, what is typically the minimum standard? Our senior administrators want to set the standard at 100% accuracy for our clinic physicians, who must assign their own codes. I am not comfortable with 100%, only because we are only human and this leaves absolutely no room for human error. I suggested 95% because I believe I have read literature that this was the standard for certified coders. What do others use and do you have literature? Thank you for all responses!
100% is a little ambitious; Our threshold is 80% for mandatory re-audits. You can educate everyone who doesn't meet 100%, but keep in mind that auditing is subjective; one auditor may find that a physician only got 90% of their charts correct, while a different auditor could say that they were closer to 100%. The point of doing it at all is educating them and mitigating any risks of submitting false claims; not to grade them for the sake of grading them. If they're going to insist on 100% accuracy, I'd strongly suggest providing education on proper documentation techniques, then giving the providers enough time to incorporate it into their work, before you start nit-picking them over every little issue, unless you want a whole lot of ticked-off doctors.

Texas Tech's Health Sciences Center has a great policy for their internal auditing, which actually takes the nature of the mistakes into account when doing their scoring; not all errors uncovered in an audit are the provider's fault, so you have to be prepared for that, as well. Here's a link to their policy: http://www.ttuhsc.edu/billingcompliance/documents/BCP_3.0_Cod_Doc_Improv_042111.pdf


The main page is here: http://www.ttuhsc.edu/billingcompliance/policies_procedures.aspx
It's a good resource to model your plan after. Hope that helps! ;)
 

MnTwins29

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Thank you!

Brandi, the policy and procedure from TTU is fantastic - thank you! I really like the points system for different types of errors - would also help "sell" a 95 percent threshold for points or even 100% if the mistake is not the MD/coder. I also bookmarked the site for other helpful documents.

You and some other very helpful people (Pam, Tessa, Deborah, etc) are why I visit this forum frequently - thanks again!
 

btadlock1

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Brandi, the policy and procedure from TTU is fantastic - thank you! I really like the points system for different types of errors - would also help "sell" a 95 percent threshold for points or even 100% if the mistake is not the MD/coder. I also bookmarked the site for other helpful documents.

You and some other very helpful people (Pam, Tessa, Deborah, etc) are why I visit this forum frequently - thanks again!
Thanks! I thought the points system was awesome, too - it doesn't quite fit perfectly with our company's structure (since we're not a teaching hospital, as they are), but it's good enough to use as a template to design your own policy. Did you get a chance to read their notes on EMR defaults? Great stuff...

I think that they had a run-in with the OIG a few years ago, and their compliance program's robust-ness came out of that. Anyways...glad I could help! :D
 
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