Assignment

Creating and Audit Plan and conducting sample audit this point you should be ready to create your audit plan. You should have previously chosen your scenario, completed fact finding for the action steps in for the audit plan, added your sample audit data, and determined the necessary actions to prevent the scenario from happening again.

Be sure to include the 5 stages of the audit cycle and how they apply to the scenario you selected. (The stages are: Preparation, selection of criteria, measurement, implementation of changes, and repeat of audits to assess sustainment of improvements).

Your final paper must 5 pages long. It should demonstrate a strong thesis statement supported by research from at least 5 different sources for each of the seven elements (Wikipedia is not an acceptable research source). Include both in-text citations and a References page in APA format.

Project Overview

Your readings in this module describe in detail the five stages of an audit cycle. Using those stages as your template, choose one of the three scenarios below and create an audit plan. Include how you will achieve each stage/step.

Use one of the three scenarios listed below to formulate your audit plan:

1. Claims are being submitted to the payers 30 days after the patient's visit. The expected time for claim submission is within 14 days of the visit. Preliminary fact finding suggests that the delay in claims submission is due to delays in the authentication of the clinical documentation needed to code and prepare the charts for billing. Prepare an audit plan to decrease the number of days between the patient's visit and the submission of the claim for services rendered.

2. The practice has been receiving denials because medical necessity has not been established for procedures and treatments reported, but not documented in the patient's health record. Prepare an audit plan to improve the documentation in the patient's health record to support medical necessity. Include a plan for any education that will have to be done with coding and billing staff, as well as physicians.

3. Physician A frequently uses the copy and paste function when documenting in the patient's health records. This has caused all the claims to be billed at a level 3 regardless of the care received at the visit. Prepare an audit plan that will include an audit of Physician A's claims to determine how the documentation can be improved to accurately bill the appropriate level of service. Your audit plan should include who will be involved in this process: the compliance officer, the physician, and coding staff.

Your final document will be an audit plan based on the scenario that you have chosen. Include sample audit data to support your audit plan.