Corporate Compliance

Tip: Compare physician vs. facility documentation when auditing your ED

Compliance Monitor, May 16, 2007

To combat the endemic ED problems of insufficient documentation, missing procedure/supplies charges, and insufficiently trained clinical staff posting charges, consider performing a thorough audit of your ED.

Diane R Jepsky, RN, MHA, LNC, president and CEO of Jepsky Healthcare Associates in Sammamish, WA, recommends that hospitals pull a sample of 40 records. Adhere to the rule of "the two 'R's" when taking this sample, Jepsky says--make sure the records are random and recent.

Then, compare what is coded on the professional side vs. the facility side. "If you get a sheet that shows the coding done for the professional side and the facility side, and they're different, that gives you a heads-up that there's a potential problem," says Jepsky.

For example, if a coder charges critical care for a physician's professional services, and the facility has charged only a level-three visit for the same encounter, downcoding is the likely culprit. "The coding should not be exactly the same, but it should be in the same ballpark," Jepsky says. "If there's critical care documented on the physician side, you should see critical care, or at least a level-five response, on the facility side."

If you've uncovered a problem or suspect a larger one, pull records containing specific code ranges. For example, pull 20 level-five physician E/M charts and the matching 20 facility charts.

Most Popular