Published on February 24, 2014
Debbie Abbott Resolutions (Int) Pty Ltd
Why Audit? ◦ Compliance ◦ Quality ◦ Revenue
AUDIT TYPE •Amount •Size •type
ABF Trim points •Diabetic ulcer
ENDOSCOPY CODING Gastroscopy and Colonoscopy ◦ ◦ ◦ ◦ ◦ DOCUMENTATION PROCESS FOR CODING REFERRAL WRITTEN PROCESS DRG CHANGE
•Cosmetic vs medical •Type C •Type changes •Underfunded
ORTHOPAEDICS MEDICAL NECESSITY CARDIAC SURGERY
Internal audit PROCESSES
Education Documentation Auditing
EDUCATION Abstraction skills
TESTING •KPIs •Speed •Accuracy
CODING • Guidelines • Documentation • Coding clinics
FRAUD Health insurance Family Edits Records HIPAA
TOOLS • ENCODER • PLUG IN HOSPITAL REIMBURSEMENT • WAGE INDEX • DOCUMENTATION GUIDELINES • SPREADSHEET
BILLS • Codes • Eg. Chest x-ray • System issues • Wrong order
•SPECIALTIES •BUNDLING •OVERSERVICING
TRENDS •Aust •US •What
•DRG CHANGE •Results •benchmark
Benefits Issues Revenue Compliance Quality
DOCUMENTATION FOLLOW UP Treatment
• 450 records ($700,000) • 200 records ($250,000) • 50 records ($28,000)
Consideration of your auditing role Documentation, documentation Education – how do we address levels? Selection of new coders Trends Coding audit outcomes – do we learn??
Contact Information: • Debbie Abbott Debbie@resolutionsint.com Phone: 61 413 018775 61 7 3849 6885 http://www.resolutionsint.com
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