Reference no: EM133237917

1. What is the focus of the audit?
2. What documents are included in the audit?

Case Study
Review the audit scenario provided below. Write the appropriate responses to the questions below. Calvin is the Compliance Director at Memorial Hospital. He has been preparing 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 perform the audit on-site at Memorial Hospital. The auditors will have access to the EHR medical documents, CDI queries, responses, and the UB-04 billing form for each inpatient admission to validate reported secondary diagnoses and 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 before 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 the coding unit could have missed a higher level of severity. The coding unit has an accuracy rate metric of 92 percent. The code will determine the compliance rate for the audit over the code method. The audit will take place during the fourth week of March. After 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 delivered within three weeks of the end of the audit.