Medical auditing plays an important role in providing accurate and efficient documentation for any healthcare organization. This medical auditing helps to figure out the areas in which healthcare providers need to improve.
The Quality health care offered by an organization always depends on accurate and complete clinical documentation in the medical record. The best way to improve your clinical documentation and growth level of your health care organization can only be achieved through medical records audits.
What is Medical Auditing?
Auditing is a common word and of course everyone aware of it, it’s a process of verifying the records of a company whether everything is perfect. In the same way, medical auditing is the process of examining the medical records to make sure that the doctors and medical equipment and facilities offered in a hospital or clinic comply with the standard rules and regulations of the medical field.
Medical Auditors – What They Do?
The main role of medical auditors is to conduct an internal and external review of coding accuracy and procedures of a medical provider to ensure cost-effective delivery of care to their patients.
As there is a huge change for the occurrence of documentation errors, medical auditors are responsible for identifying the errors in the documentation process such as loss in accreditations, physicians’ licenses, or Medicare status. Besides, the medical auditors are also responsible to give a clear view of the correct documentation procedure and provides details about the coding rules and insurance guidelines.
Benefits of Medical Auditing
1. The irrelevant coding or coding errors will lead to the claim denials, medical auditing helps to find out and correct the issues before the insurance or government payers challenge inappropriate coding.
2. The unnecessary billing will either affect the healthcare providers or the patient. Medical auditing is one of the ways to prevent such fraudulent claims and medical billing activity
3. Under coding happens when patients are not charged for all the treatment or administrations rendered. These fraudulent activities can result in audits and investigations. Medical auditing helps to avoid this kind of problems and to bill appropriately for documented procedures
4. It’s medical coders’ responsibility to research any new or reorganized codes as they arrive out, and use them correctly. Additionally, auditing helps to stop the use of outdated or incorrect codes for procedures and start with the new coding process.
5. Medical auditing determines outliers before large payers find them in their claims software and request an internal audit be done.
6. It helps to identify reimbursement deficiencies and opportunities for appropriate reimbursement.
7. Medical auditing helps to verify ICD-10-CM and electronic health record (EHR) meaningful use readiness
Auditing Medical Records
Decide Your Audit Focus
The main purpose of your audit is to identify the medical practices that are inconsistent or which needs improvement. The audit process should have some basic characteristics such as it need to be specific, measurable based on the data available in the records and it is very important to the efficacy of your hospital and the care of your patients
Define Measurement Criteria
After you’ve recognized the focus of your medical records audit, decide the specific measurement criteria for the review. Finally come to a conclusion on which factors will decide whether or not these criteria are met.
Performing a literature review can help to speed up the process, since utilizing techniques previously demonstrated to be successful takes out the need to build up your guidelines for estimation. Literature reviews can likewise give benchmarks to examination.
Determine Which Records to Review
First identify the precise patient population which needs to be evaluated, because this only helps you to choose which records to include the audit. Consider the clinical status, gender & age, treatment routine, and be sure everybody engaged with the audit knows exactly what decides if a patient is incorporated or prohibited. Often the focus of the audit and the estimation standards will guide this decision.
Decide Sample Size
Completing an audit of every chart which meets your incorporation rules is normally not achievable. So the best guideline is to pick around 10 percent of the qualified chart to audit. Statistical significance is heavily affected by the sample size—if insufficient records are audited, the variables will be too numerous and the audit results will have restricted application.
Develop Recordkeeping Tools
The important aspect in auditing is to organize the audit results in such an easy to access way that allows for evaluating individual records as well as aggregate data. For this thing, how you plan to collect and analyze audit results is very important. Here comes the use of record-keeping tools. These types of tools help you record your results, for instance, electronically data record and paper-based system records.
Checkout For Errors And Summarize Your Findings
This is the most crucial step in performing your audit because irrelevant data can result in an inability to use the audit results to enact change. So be careful and reflect on how the findings will be used and summarize the data in the efficient way.
Auditing medical records may seem to be a long process but it is very important and at the very least, your practice should be internally audited at least once a year. The data contained within these charts can be very useful for improving healthcare efficiency and ensuring patient satisfaction. It’s important to use all of the resources at your disposal to provide the best possible experience for your patients.