Making the grade: Use chart audits to tailor provider education
Everyone appreciates a customized experience and that holds true when it comes to provider education. Interdisciplinary team meetings are the perfect venue for revenue integrity to present regulatory and payment system changes that impact all providers or to discuss overall trends, but they don’t offer the chance for one-on-one discussion and improvement. Each provider might struggle with a different topic or have different questions to dig into that can’t be squeezed into a group meeting. To help craft personalized education and improvement tracks for providers, revenue integrity can use existing data from chart audits to build a road to success.
At Saint Luke's Health System in Kansas City, Missouri, revenue integrity analysts (RIA) pull a sample of 10 charts per provider per calendar year to conduct chart audits, says Sheri Bayless, CPC, CPPM, director of site of service revenue cycle at Saint Luke’s. The RIA reviews the provider’s documentation and ensures that it supports the submitted code and that the chart is not missing documentation. The latter is crucial, Bayless says, because missing documentation could have supported the use of a different code.
The next step is to translate the chart audit’s dry list of documentation and coding reminders into something the provider will be able to grasp at a glance. The RIA tallies the provider’s chart audit score. Each chart is worth 10% and the chart can be either correct, netting the 10%, or incorrect, losing that 10%. For example, if eight out of the 10 charts reviewed by revenue integrity are correct, the provider would have a score of 80%. At Saint Luke’s the goal is for each provider to score above 90%, so a score of 80% would trigger the revenue integrity team to take action.
Bayless’ team creates a re-audit schedule based on the providers’ score. If the provider scores above 90%, the RIA will follow the standard procedure of re-auditing in a year and scheduling an annual one-on-one meeting with the provider to go over the chart audit results. If something comes up or changes, the provider can request to meet with the RIA sooner. For providers who score in the 80% range, the RIA will re-audit in six months, and if the score is below 80% the RIA will re-audit in three months. At each one-on-one meeting with providers who fall below 90%, the RIA explains the score and offers tailored education and resources to help the provider improve, Bayless says.
“We’ll re-audit until we can get those scores up higher because that shows that they’ve got a good understanding of the education that they’re receiving for proper documentation,” Bayless says.
The chart audit and education process at Saint Luke’s is yielding positive results, she adds. Previously, not all the employed providers were scheduled for even annual reviews to discuss chart audit results and personalized education. But the expansion of Saint Luke’s revenue integrity program and its plan to move physician/ambulatory clinics to Epic opened the door for Bayless to introduce new, more refined processes. The move to Epic made a robust chart audit and provider education program even more critical.
“Our goal was to ensure that every employed provided had a meeting with an RIA during that first calendar year for an audit review,” Bayless says. “And we were also on a new EMR, so making sure we had our templates built correctly, what they were documenting was pulling to the record, etc.”
Although getting the ear of providers can be difficult, Bayless discovered that providers generally responded well to the new audit and education process. The regular, one-on-one schedule helped the providers realize tangible benefits and dig into specific topics that might be rushed through in a group meeting. By taking a customized approach, Bayless’ team was able to make individual success support the organization as a whole.