General Question for the Week of March 13, 2017

General Compliance Question of the Week

Question:

Can you provide any tips for conducting chart audits?

Answer:

If you work in a hospital setting, here are some considerations around chart audits from the Centers for Medicare & Medicaid Services:

• Select high-risk cases to audit as well as cases for which there is a diagnosis-related group (DRG) shift between ICD-9 and ICD-10 to identify patterns of incorrect coding.
• Follow the entire workflow for each record type—inpatient, outpatient, same-day surgery, emergency department, and recurring accounts—including Medicare, Medicaid and commercial cases.
• Review surgical procedures that need clusters of codes for accurate reporting (e.g., removal and replacement of joint prosthetics).
• Review high-risk and resource-intensive DRGs to ensure accuracy.
• Review surgical cases to determine if surgical approach is reported correctly.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.