audit sample

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Thu Dec 14, 2017 9:12 am

I am trying to determine what would be an appropriate number of charts to audit per provider for a surgery department with 9.5 coders and 42-44 surgeons plus the NP/PA's. This audit would include OR notes as well as E/M notes. I am having trouble determining the appropriate number for the department and per provider. Are there any guidelines that might be helpful for this?

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Thu Dec 21, 2017 10:10 am

This answer is assuming that you are performing a baseline audit- meaning you are just trying to cover as many categories of care within your practice, and not targeting any certain services. The OIG would consider as few as 5 encounters per provider to be a “compliant” audit, but what can we really observe from such a small sample. This information is covered in the first link below on page 4 third column last paragraph.

The industry average is 10-20 encounters per provider, and since your providers are performing surgical services I would suggest the higher sample. This will allow you to include new, established, inpatient, and surgical services into your audit plan. I would also recommend looking at a few entire global packages from the point of decision for surgery through all phases of follow up care. Sometimes examining the full global gives a better picture of the entire course of the surgical care process.

Now, I have one more thought for you. There is a software program that will evaluate your providers true areas of risk. With the baseline audit, you may be spending dollars on auditing services that your providers do not have as high exposed risk in and potentially missing the audit concerns of their high risk services. We would recommend you take a review of CRA, Compliance Risk Analyzer (a link is provided below), to help structure your audit for a risk based approach in lieu of the shot gun splatter approach of a baseline audit.

OIG Link:

CRA Link:

Your question has been answered by Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT
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