Health Information Management

Perform regular query audits to ensure effectiveness

HIM-HIPAA Insider, March 3, 2009

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Facilities should regularly perform query audits to ensure they are effective. To do so, monitor the query process by reviewing a representative sample of all queries performed and a sampling of a specific coder’s queries.

According to AHIMA, an effective program should audit the following:

  • Percentage of positive and negative query responses. A high percentage of negative responses may mean coders are querying unnecessarily, whereas a high percentage of positive responses may indicate physicians may need education to rectify a pattern of incomplete documentation.
  • Format of queries. Education for coding professionals may be necessary if trends showing inappropriate query formats are present.
  • Individual providers. This format of monitoring will indicate whether specific healthcare providers would benefit from additional documentation improvement education, resulting in a decreased number of queries for the provider.
  • High-risk diagnoses. Auditing problematic diagnoses may show whether additional education on specific diagnoses would be helpful.

Editor’s note: This tip was adapted from a white paper on physician queries that was published on HCPro’s Revenue Cycle Institute Web site. Download a free copy of this white paper by visiting the site.



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