Amazing auditors will audit 200 records

Reference no: EM133637048

Instructions

Review the audit scenario provided below. Place the applicable portions of the scenario into the correct audit plan category by following the prompt in the figure below.

Scenario

Calvin is the Compliance Director at Memorial Hospital. He has been an audit that was required by the chief financial officer (CFO). The audit results will be presented to the hospital executive committee. The focus of the audit is the CC/MCC capture rate. The coding dashboard includes this metric for the top five MS-DRG families. The capture rate has been decreasing over the past six months. The CFO wants to identify the root cause of the decrease and implement solutions as soon as possible.

Calvin has contracted with Amazing Auditors to conduct the external review. Amazing Auditors is a local firm and will conduct the audit on-site at Memorial Hospital. The auditors will have access to the EHR medical documents, CDI queries and responses, and the UB-04 billing form for each inpatient admission to validate reported secondary diagnoses and to identify unreported secondary diagnoses.

Amazing Auditors will audit 200 records from the past 12 months (February 1, 202X through January 31, 202X). This will provide information for encounters prior to and during the CC/MCC capture rate decrease.

Calvin is going to use a stratified random sample to identify the admissions for the audit. He is selecting records from no CC/MCC MS-DRGs and from with CC MS-DRGs. Both categories represent MS-DRGs where a higher level of severity could have been missed by the coding unit.

The coding unit has an accuracy rate metric of 92 percent. The compliance rate for the audit will be determined by the code over code method. The audit will take place during the fourth week of March. At the completion of the audit, Amazing Auditors will provide a debrief with representatives from HIM, coding, compliance department, patient financial services, CDI, and the CFO. The written report will be provided within three weeks of the end of the audit.

Reference no: EM133637048

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