CoAudit™

Datasheet (289 kb)

Simplify compliance. Uncover lost revenue.

In the business of healthcare, staying within government compliance regulations and making sure revenue is optimized is a daily responsibility. In addition, the Office of The Inspector General is increasing resources to actively seek patterns of fraudulent billing. Manual auditing is far too slow and time consuming to stay on top of these demanding and continuously changing regulations. CoAudit™ is the first coding audit software tool to simplify compliance and uncover lost revenue.

Office of Inspector General Increases Audits

         With funding in place from Deficit Reduction Act of 2005, the Medicaid Integrity Program is actively seeking patterns of fraudulent billing (intentional or not) to the Medicare and Medicaid programs. Also, the DRA is providing the Office of Inspector General (OIG) with additional resources to investigate fraud and abuse activities.

          “Thanks to the targeted funding provided by DRA, OIG will continue to devote substantial resources to auditing, evaluating, investigating, and prosecuting abuses in the Medicaid program. OIG identifies payment issues and errors, uncovers program vulnerabilities, recommends improvements to the program, and, when necessary, pursues appropriate law enforcement actions to recover funds paid to fraudulent providers. OIG will also continue to collaborate with CMS, State auditors, MFCUs, DOJ, and other government enforcement agencies to identify, prevent, and deter fraud and abuse. The management and fiscal integrity of Medicaid is a top priority for OIG.”
– Daniel R. Levinson, Inspector General, March 28, 2006

Loss Of Revenue From Downcoding

         Cash flow losses can reach hundreds of thousands of dollars from incorrect coding. Everyone agrees that proper documentation and coder training help to alleviate the problem, but where do you look?

         According to the American Academy of Family Physicians, if the difference between the Medicare allowable amount for the level of service you code and the level of service you actually provide is $27 on average, you're losing approximately $240 per day. This is a significant loss, but not nearly as impressive as the corresponding annual loss of $57,600 per physician.

Manual Auditing Is The Old Way

         What’s the correct sample size? Which records should be analyzed? Where are the records? These are common questions when performing a manual audit. Instead of guessing, CoAudit automatically produces a statistically correct audit sample based on confidence level, coder error rate, auditor error rate, and error margin. As a result, your audit samples will be representative of your total population of claims.

Automatic Auditing with CoAudit

         CoAudit will transform the way you audit. Instead of yearly or quarterly audits, you'll be able to perform audits on a monthly or weekly basis. CoAudit determines the sample size, pulls the records, and lets you compare original records to those coded with CPT codes and ICD-9 codes. And to see how well your coders are performing, an automatic Scoring System tells you who is doing well and who needs training. Your business will be more efficient and save money in the process. And if you’re chosen by the OIG in a random audit, you’ll have nothing to worry about.

How CoAudit Works

         CoAudit makes creating an Audit Report fast and easy. First, you select your audit parameters, such as CPT code, ICD-9 codes, Modality, Code Pairs, Coder, Physician, or Payer within a particular date range. Next, you chose the sites you want to audit. CoAudit will automatically calculate the statistically correct sample size. Your medical records will then be displayed on the screen, allowing you to compare the records (demographics and procedures) to the CPT codes and ICD-9 codes assigned. You can then make corrections as needed, or accept the document as it was originally coded. Finally, CoAudit will generate the Audit Report, based on the parameters you selected. You can also save the parameters as a template and easily generate additional audits.

Uses Proven Statistical Sampling and Scoring

         Behind the easy to use interface, CoAudit utilizes a sophisticated statistical methodology. A-Life Medical's team of engineers and PhD scientists have created a system that goes beyond OIG recommendations. Based on proven sampling and scoring equations, CoAudit gives you a realistic view of the state of your medical records.

CoAudit Key Benefits

• Dramatically reduces the cost and time to perform an audit (from months to hours)
• Eliminates manual selection of documents using a statistical sampling process
• Automatically creates a summary and detailed Audit Report
• Identifies revenue losses from downcoding
• Identifies coder accuracy of CPT codes and ICD codes

CoAudit Key Features and Capabilities

• Automatically determines the appropriate sample size from a population of records
• Numerous selections of filtering parameters including Coder, CPT code, ICD-9 code, Code Pair, Modality, Date Range, Physician, Referring Physician, Payer Code, and Payer Class
• Provides scoring of coders to track accuracy and improve efficiency
• Saves parameters in a template for future audits
• Controls access using three levels of secured permissions
• Provides access to data across multiple sites
• Creates detailed Audit Reports based on Coder, CPT code, ICD-9 code, Code Pair, Modality, Referring Physician, Payer Code, and Payer Class

Resources

Department of Health and Human Services
http://www.dhhs.gov

Office of Inspector General
http://oig.hhs.gov

Compliance Guidance for Third Party Billing
http://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf