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)
Information everyone can use
If you have a CDI in place, outcomes from multiple audits can help inform the results – and visa-versa. Insights from outcomes can also be used to educate the HIS team and individuals throughout the wider hospital structure – from clinical personnel to management.
The most common audits we see
There’s a number of typical audit categories we see at Code Focus on a fairly regular basis – both across the public and private sectors:
- Coder Inaccuracy – to identify if there were audit or DRG changes due to coder error.
- Unsubstantial documentation – to identify if an audit or DRG change was due to missing or incomplete documentation.
- DRG changes due to coding changes – to identify if an audit or specific DRG change was the result of coding changes (which may be due to coder inaccuracy).
- Administration process error – to identify if an audit or DRG change is due to an administrative or process error with the patient record.
- DRG changes due to coding, auditor or CDI queries – to identify if an audit or DRG change was because of a query. These query types can be broken down in the audit outcomes as Coder, Audit, or CDI – enabling the HIM to understand the specifics of a query or who influenced the change.
- Audit types: CDI and Auditor – to specify whether an audit or DRG change was the result of actions from an audit by a CDI specialist or HIM auditor.
The benefits far outweigh the time it takes
We believe the returns that come from revisiting your areas of focus and rules vastly outweigh the efforts you put in. They will positively impact your hospitals reporting, planning, troubleshooting, training and, of course, reimbursements. Learnings from multiple audits can also provide the necessary substantiation for implementing change.
In our next article in this series, we’ll be looking at how to create some of the most common rules for multiple audits and what typical challenges many hospitals experience while conducting multiple audits.
We’re here for you
If you would like help with undertaking a strategically aligned multiple audit campaign, the Code Focus team is more than happy to conduct complimentary workshops or one-on-one advisory sessions with your department. All requirements will remain confidential and you’ll also learn about getting the most out of your Code Focus software. Contact Callum Haggerty at Data Agility.