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Wiki compliance auditing

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davisph

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Local Chapter Officer
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I am new to auditing in compliance and wondered if their is any kind of resource that can help me better explain my findings when I am performing an audit. I have a background of post service review of claims and E&M audits but it is not helping me when it comes to hospital audits. Please direct me if possible!

Phyllis D- CPC, CPC-P, CPC-I:confused:
 
I need help in operationalizing the audit when I am writing the report. I wondered if there was some guide to give me more understanding on how to write my findings. Hope that helps explain it more.

-Phyllis
CPC, CPC-P, CPC-I
 
I am not sure if this is what you are looking. How about listing each finding or observation then the recommendation falling it.

Findings (observation):
Recommendation:

Findings (observation)
Recommendations

If you have the book Medical Record Auditing by Deborah Grider there are example of audit reports.

Hope this helps

Cheryl
 
Always indicate in your report the total # of samples reviewed, what type services are included in the sample selection and what the requirements are.

Example: As part of the compliance program's work plan I performed a billing, documentation and coding review. The review consisted of 10 samples relative to your services to monitor coding accuracy and teaching physician rules, with results summarized below.

Always start off with letting them know the results up front, example:

7 out of 10 samples were coded at the correct level.

In the report you can display your findings like this:

Inpatient consultations (99254):

Reminder:
Level 4 inpatient consultations require the documentation of:

- a comprehensive history (4 HPI elements, 10 (or more) ROS, all 3 PFSH) and
- a comprehensive exam (8 organ systems) and
- moderate MDM

2 of 3 samples reviewed; 99253 billing was supported for the following reasons:
- history level detailed; 10 (or more) ROS not documented
- physical exam detailed; 5-7 organ systems documented

This is an example for E/M services, hope it helps.

Maria Candia CPC, CPC-H, CPCO, CPMA, CEMC
 
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