maine4me
Guru
Okay, I am very frustrated and need to run this by someone. I have been charged with setting up an internal audit process for our medical practices. We have 7 practices of different specialties. When I first began at the beginning of 2012, I was given the ball and told to run with it. So, I began with our family practices. I did baselines audits consisting of 15 records per doctor, did a detailed analysis (outlining reported codes, documented codes, errors and areas of improvement), and I did an audit summary advising each doctor of his or her percentage of accuracy and what documentation issues needed to be addressed. After sending this information to the doctor, I set up meetings to review the results and begin the education process. All has gone very well.
As part of that process I set an initial expectation of 85% for the percentage of accuracy, to eventually move to 90 - 95% as the program grows. I had used an initial sampling of 15 charts because I felt this helped me to get a good sampling of the different services provided. The plan was that if the doctor fell below the 85% mark, (most of them did) then I would meet with them in 3 months after reviewing 5 charts as part of the followup audit, and if they exceeded this mark we would not meet for 6 months.
Now, the hospital that owns our practices has added audit requirements to the doctors' contracts. However the language states a 75% accuracy level and that 20 charts will be audited in the one year period. My problem is that the hospital and I have given two different accuracy requirements, and that if the problem is not having any coding/documentation issues I may not audit them but twice a year. If a followup audit consists of 5 records, then how do I achieve the twenty mark. I suppose I could audit 10 records. two times a year, and for those doctors that require audits in between I could make them consist of 5 records.
Will someone tell me if they have dealt with this type of issue, and how they handled it?
As part of that process I set an initial expectation of 85% for the percentage of accuracy, to eventually move to 90 - 95% as the program grows. I had used an initial sampling of 15 charts because I felt this helped me to get a good sampling of the different services provided. The plan was that if the doctor fell below the 85% mark, (most of them did) then I would meet with them in 3 months after reviewing 5 charts as part of the followup audit, and if they exceeded this mark we would not meet for 6 months.
Now, the hospital that owns our practices has added audit requirements to the doctors' contracts. However the language states a 75% accuracy level and that 20 charts will be audited in the one year period. My problem is that the hospital and I have given two different accuracy requirements, and that if the problem is not having any coding/documentation issues I may not audit them but twice a year. If a followup audit consists of 5 records, then how do I achieve the twenty mark. I suppose I could audit 10 records. two times a year, and for those doctors that require audits in between I could make them consist of 5 records.
Will someone tell me if they have dealt with this type of issue, and how they handled it?