How can you get the most from multiple audits?
Uncovering the likes of incorrect coding, lost reimbursement opportunities, missing documentation and repetitive problems have always been at the heart of multiple audits. But for many HIMS, no matter how many rules they apply and categories they target, there’s always a question of ‘Did I miss anything?’
Looking at audits through a variety of lenses is important. Knowing which lens to choose for the results you need is an entirely different subject.
Essentially, it boils down to how you expect to use the data as a result. Indeed, the outcomes can help steer a number of departments and, ultimately, hospital performance.
By writing and running different rules during audits you can gain unique perspectives and a deeper understanding of your operational status quo. Also, the data outcomes can facilitate learning – for both departments and individuals.
Multiple audits provide a multitude of perspectives
We all know that, by viewing audits from different perspectives, your understanding of existing and emerging issues becomes so much clearer.
Naturally, every hospital has its unique challenges – so the focus of your audit queries should reflect your specific circumstances, regardless of whether you’re a public or private operation.
That said, many approaches to audits are fairly typical across the industry. To obtain accurate data for any individual query, however, the rules you apply will need to be quite specific.
Some of the areas you may want to focus on include:
- More reliable reporting to reduce the likelihood of contested outcomes
- To find out why certain episodes are getting flagged – and whether the queries lead back to a specific coder or clinical documentation supplied
- Quality of coding and whether your own HIS team needs support or training
- Which hospital departments need work – such as help in supplying more insightful/accurate documentation, code education of clinicians, or whether a CDI system should be adopted
- Hard evidence that you need to employ a CDS
- Data required for statistics and developmental planning
Where to start?
Whether you wish to conduct your multiple audits out of exploratory reasons – such as finding any anomalies across cases – or whether you need to get hard data to support a business case, it’s important to be specific about your audit rules and what you would like to achieve with the outcomes.
There’s no right or wrong way of approaching multiple audits. However, it does help to consider the many options open to you:
- Auditing by segments – such as the finance department, HIS department, clinical departments, or administration, etc.
- Auditing in specific areas of interest, including:
- Coder accuracy and errors
- DRG change types
- Coding changes
- Missing/incomplete documentation
- Query types, resulting in changes
- Process errors
- Coding and DRG changes
- Coding changes without DRG changes
- DRG changes without coding
- Audit type changes (eg, CDI)
