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Thread: Chart Auditing

  1. #1

    Question Chart Auditing

    AAPC: Back to School
    How ofton should you do chart audits, twice a year? How do you select what charts to audit? I am looking for a good starting point.

    Jeannie Hortman CPC

  2. #2
    Join Date
    Apr 2007
    Portsmouth Virginia


    Not sure if there is a "true" format, but I do them as such.

    I take 10 records per provider and review them for all coding (ICD-9, CPT/E&M). If they are under 90% accurate then I redo the audit at six months. If they are still below 90% accurate I perform them quarterly until they get to 90%. (I also alternate between pre-claim and post-claim reviews).

    I have found this is the most beneficial. I also take the time between each audit to perform mini-bursts of training sessions with the providers on their "weak" areas.

    Just my .02 worth, hope that helps

  3. #3
    Join Date
    Apr 2007
    Louisville, KY


    If you're looking for a starting point, take a look at purchasing the Ingenix Audit Tool.

    Keep in mind that just "base numbers" rarely seem sufficient. I employ the theory of valid random sampling. You need a target. Some folks are happy with XX amount of charts per provider per quarter, or whatever. Statistical validation adds a whole chunk of weight to your findings.

    I would even go as far as to say that if internal auditing was part of your compliance plan, it should certainly be spelled out to have basis in statistical validation. In the event of any future interventions from payer sources or other outside audits, your findings can lay in direct dispute of that, with statistical validation. Of note, payers are employing statistical validation when they're analyzing your claims, why not make use of the same tool?

    Check out that Ingenix product. I think it might educate you and help you to create something useful in terms of audit.

    Good luck.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

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