Wiki How do you Score a Provider Audit?

LauraNewYork

Networker
Messages
68
Location
Clay, NY
Best answers
0
I'd like to hear how others score EM level audit results. We are just initiating internal prebilling audits for our 21 MDs. We are starting with completing 10 charts for each provider annually as there are only 3 FT EM coders who will also be doing these audits.

Based on a recent workshop, I attended we are scoring EM using this method:
10 charts, total possible score = 100
Correct Code 10 points
Over coded by one level 8 points
Over coded by > one level 0 points
Under coded 5 points
No documentation 0 points
Incorrect category of E/M code 5 points

If a provider has a score less than 90, then subsequently focused audit is done. Does anyone have a different method of scoring EM results?
 
I have started using https://compliance.bsd.uchicago.edu/Documents/MDaudit_Guidance_OCC_Website.pdf for our department. I like the methodoly for it as it has been able to show us what are provider coding errors, coders, billing, front office, etc. and then we are still able to assign a score to them and set them up for either a re-review or annual based on the score. If they get an error rate of 7% or more, they get a re-review from the internal auditing team. Provider Audit Results Tip Sheet
 
I have started using https://compliance.bsd.uchicago.edu/Documents/MDaudit_Guidance_OCC_Website.pdf for our department. I like the methodoly for it as it has been able to show us what are provider coding errors, coders, billing, front office, etc. and then we are still able to assign a score to them and set them up for either a re-review or annual based on the score. If they get an error rate of 7% or more, they get a re-review from the internal auditing team. Provider Audit Results Tip Sheet
Thank you for the information.
 
Top