General Question for the Week of March 13, 2017

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.