Chart Auditing-Compliance Commitee Otolaryngology

cwater

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I am interested is establishing a process/committee to audit Otolaryngology physician charts internally. We want to verify that medical necessity documentation is being met for procedures and that the documentation supports the CPT's billed.

Has anyone set up an internal auditing process or does anyone have an internal auditing process in place that could give me some direction?
Do you audit E/M's based on the CMS score sheet or do you use an automated program? How many people are on your committee and what degree's/credentials do they hold? What is your process for reviewing the charts and how do you address your findings with the physicians?
Any assistance and/or direction would be greatly appreciated.

Thank you in advance for your assistance,
Camille Waterhouse, CPC
 

Chelle-Lynn

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We have an internal auditing group. The committee is made up of our compliance officer, medical director, and 3 CPC/CPMA. We complete a manual audit of the E&M codes. We do have an automated system, but we prefer to review by hand to ensure accuracy. This allows us to take into account time spent, medical necessity, etc.

The results are returned to the Compliance Officer and Medical Director for information, and the results are presented to the physicians individually with a copy of our audit and medical records on the ones we disagree with. This allows them to see how we came up with the differences in leveling. Based on the results, if an individual physician does not pass with a 70% or higher on their coding the Compliance Officer will request a 30 day audit of the provider to provide training and feedback to improve their pass ratio. This is an audit of all accounts by that provider in the 30 day timeframe.

Please let me know if I can provide more information. Good luck!
 

cwater

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Thanks for your response. What auditing software do you use? Is there a way to store the charts to be audited so that the committee members can access the documents and program remotely?

My physicians are spread over two states and it is very difficult to get them all together. I am looking for a way that the charts can be audited from a remote location with an auditing software. An example would be something like the interactive E/M scoresheet from CMS. This option lacks the ability to score anything but E/M's and does not have a way to securely store the chart to be accessed remotely. We want to be able to audit the chart for multiple different coding senerios like the appropriate level or service, verify the medical necessity of procedures billed with E/m's, op notes and services rendered. Any suggestions? Thanks, Camille Waterhouse
 

Chelle-Lynn

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There is one through Decision Health Select Coder that is user friendly. For us we scan the auditing sheet and medical records to the provider for review so that we are all looking at the same information when there are questions or concerns. We are all within the same county so we do have the traveling or distance issue that you appear to. :)
 
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