LIGGETTJEFFDRGAuditQuestions

School: Tacoma Community College - Course: HIM 465 - Subject: Accounting

1.What type of audit sample is represented in this data? o Statistical Audit Sampling 2.What is the criteria for the sample size? o Statistical audit sampling involves a sampling approach where the auditor utilizes statistical methods such as random sampling to select items to be verified. Random sampling is used when there are many items or transactions on record. Consider a company with more than 100 inventory transactions on its records. Using statistical sampling is recommended due to the high number of transactions. 3.Does the sample size make sense based on the population of 619 cases? Explain your answer. o Not exactly, the sample size used was very small compared to the large total number of charts. The sample size should have been 10% of the total which would have been around 62 charts. This would have been a suitable number to offer accurate results. The 7 coders were given varying number of charts to audit. This was inappropriate since there cannot be a proper evaluation of the results gotten by each of them. They should have been given around equal samples so as to identify the pattern. 4.What do you observe about the distribution of records obtained for each coder? o The distribution of records observed is varied. The audit procedure that was employed was probably efficient in locating coding problems and producing suggestions for how to make things better. However, it is not apparent how frequently these audits are carried out or how many different cases are examined. 5.Can this data adequately represent organizational accuracy for the coding of MS DRG 195? o The primary advantage of using a statistical sampling approach is that risk is objectively determined. It is a widely accepted methodology in an audit or other review of healthcare claims to identify improper payment amounts. When performed in a valid scientific manner, statistical sampling permits the auditor to estimate overpayments in a universe of claims that may be too voluminous or complex to permit a claim-by-claim review. Statistical sampling saves the time and expense of reviewing the entire universe of claims by allowing a small sample of claims to be analyzed. 6.Can this data adequately represent individual coder accuracy for MS DRG 195? o No, this cannot adequately represent individual coder accuracy since statistical audit sampling is based on collecting and evaluating information about a large population, or universe, when it would otherwise be impractical (or impossible) to collect that information from the entire population. When done properly, statistical samples enable reasonable inferences to be drawn about the population based on information about the sample. Additionally, one will have an objective measure of the possible variation between samples and of the sample's relationship to the population.

7.What does the overall data tell you about coding opportunities for the organization? Can you ascertain any CODER opportunities from this data? o IF so, what opportunities and WHY. - This provides an opportunity to enable staff and organizations to ensure accuracy is achieved and compliance is maintained. Coding audits serve to help medical practices and health systems understand the complexity of medical coding and billing. Another service of an audit is to review the quality of coding. The series of inspections and checks performed by objective individuals ensure that the company or health care entity is in compliance with its policies and is running correctly. o IF not, what would you need to do as the manager/auditor to learn more about coding opportunities for each coder? - From the manager/auditor perspective, a coder audit should be a learning opportunity rather than a punitive process. As such, the coder's voice must be the major player in the results discussion. It is crucial to allow adequate time for coders to review their results and be given an opportunity to defend their original coding decisions. Coders should want to be audited. By allowing this time and with the right approach, it will empower coders to have healthy, productive conversations between other coders, auditors, and physicians. It will contribute to not only the coders' growth and success.