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Use publicly available benchmarking tools to enhance the audit process

Healthcare Auditing Weekly, February 3, 2004

You can use the many benchmarking tools that are publicly available to make the audit process as effective as possible. In particular, the data sets provided by the Department of Health and Human Services (HHS) are inexpensive or free and represent the industry standard. You can use this information to compare your own Medicare claim statistics to nationwide data.

The most common of these data sets is Medicare Provider Analysis and Review (MEDPAR). This is the data set for inpatient Medicare claims, provided to the public by the HHS every year. To manipulate MEDPAR data you purchase from the government, you'll have to download it into a database.

Using this data set, your hospital could look at the percentage of cases that fall into each diagnosis related group for Medicare claims, and then benchmark this against your own cases. The data can be cut in many different ways-allowing you to create your own databases that better reflect the hospital's own patient case mix. For example, you may want to look only at statistics for hospitals that are relatively the same bed size and in the same state or same type of setting (i.e. rural or urban). You can use these benchmarks during the rest of the year to continue a comparative analysis of your hospital's Medicare claims.

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