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Developing Audit Program

  1. Default Developing Audit Program
    Medical Coding Books
    Does anyone have any information on developing an Audit program for multi-speciality providers? For example we would like to incorporate provider education after the internal audit, does anyone have a protocol that they currently use? Thanks in advance...

  2. #2
    Smile Protocol
    I am the Coding Compliance Specialist for a multi-specialty, hospital-based provider group.

    My usual routine:

    1. Baseline audit all providers (10 records each; 5 new and 5 established).

    I used to do everything manually using the CMS audit form (http://www.highmarkmedicareservices....eets/8985.pdf), but now use Intelicode which I find useful for reporting and creating historical data. The audit form was fine, but it requires a little extra coordination with single system and the general multi-system 97 exams.

    2. Group Educate

    I create specialty-specific Powerpoint presentations (often focusing on problem areas discovered during audit) that I print as handouts and do "group education" where providers can ask and learn from common questions. I will usually provide them with a sealed envelope of their audit results at this time.

    3. One-on-One Education

    Review of the group education and their specific audit results.

    4. Re-audit

    This is typically a one month re-audit cycle for the first round because it is rare that a provider is at an acceptable pass rate. My own "pass rate" is 80% accuracy or 8/10 charts. Repeat education and re-audit cycles as necessary.

    I also put out a monthly coding and compliance newsletter, the TMG Coding News, which features articles targeting common documentation and coding issues as well as provides coding and coverage updates. This newsletter goes to physicians, NPPs, and billing staff.

    Hope this helps.
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

  3. Default
    Thanks Brenda for responding to my question. Your protocol sounds perfect, & sounds like it is exactly what I am looking for. Regarding your newsletter, is it possible to share this with me, and if you have any kind of tools that I could use to help develop this would be greatly appreciated. I also use the Intelicode, which is fantastic. We use this for all of our provider audits, and it is fantastic for teaching and showing the providers where they are deficient.
    Sharon Kiessling, CPC

  4. #4
    Brenda, could you send me information on your coding and compliance newsletter? I too just started a new position as coding coordinator for an 8 specialty physician group. My email address is Thanks in advance for your help!

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