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Tip: Use publicly available benchmarking tools to enhance the audit process

Compliance Monitor, February 18, 2004

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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.

For more information on using public benchmarking data, order the book "Coding Compliance: A Practical Guide to the Audit Process." This book provides step-by-step guidance on how to conduct an audit, with dozens of sample forms, reports, and tools to simplify your audits, and advice on how to follow up on the results of your audits, such as by educating staff and returning money for overpayments. Other information in the book includes: education on the need for audits; how to carry them out; follow-up activities; attorney-client privilege (how to obtain it, and when it's appropriate to seek it), and explanations on the difference between monitoring and auditing. The book also includes explanations on the interface between these two functions. Click here to save 10% by ordering online.

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