Wiki Audits of coders

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dbasssett

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We are in the process of setting up audits for our specialty areas (anesthesiology, radiology & pathology) where coders do the CPT selection from documentation. Our billing system doesn't track the coders so we can't audit X encounters per coder (as we do with providers). We are thinking that our approach will be X% of total charges which would give us an adequate mix of coders but don't know the best way to determine a reasonable sample size. Does anyone perform this type of audit? If so, will you share your methodology for determination of sample size?
 
I audit my coders on a daily basis. I had originally come up with an Excel document that allows us to track client errors, and we send those back to them for education and notification of the changes that we had to implement (modifiers, changing a repeat code to an add-on, etc.) I took that form and modified it to evaluate the amounts of errors that they let slip through. I review one batch a day for each coder. I print it, before they have a chance to review it. The very next morning, I review it and after finding the errors, I go in and see which ones they caught and did not. Then I calculate that percentage daily. Does that make sense?
 
Thank you for sharing your process. Do you audit 100% of each coders charges per day, or just spot check a few. If spot checking, what method do you use to select encounters to audit?
 
Each of my coders is assigned clients from a different geographical region - so, it's easy for me to determine who is responsible for each batch. I just do one batch, per coder, per day. I do try to make certain that they are very close in quantities of claims to keep their numbers as close of a comparison as possible. I know that percentage-wise, that shouldn't matter so much. But, if one batch has 25 claims and the coder misses one error(4 %) it's a much nicer seeming calculation that if there were 10 claims from one batch that still only had 1 error(10%).

So, at the end of the week they get feedback about things they have missed and need to be more careful about. As they improve on areas of weakness, or even refusal to correct bad habits, these things are considered on their future reviews.
 
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