CPMA Chapter 5 - Analysis And Report Of Audit Find
CPMA Chapter 5 - Analysis and Report of Audit Find
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CPMA Chapter 5 - Analysis and Report of Audit Findings Questions And Answers Latest Updates
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CPMA Chapter 5 - Analysis and Report of Audit Find
Institution
CPMA Chapter 5 - Analysis And Report Of Audit Find
Components of the Audit Report: Background: Type of audit: - ️️The most common
type of analysis an auditor is called to do is a compliance audit, which usually involves
an analysis of claims data on behalf of the provider or entity providing the services.
Background should also disclose the ...
CPMA Chapter 5 - Analysis and Report
of Audit Findings
Components of the Audit Report: Background: Type of audit: - ✔️✔️The most common
type of analysis an auditor is called to do is a compliance audit, which usually involves
an analysis of claims data on behalf of the provider or entity providing the services.
Background should also disclose the audit scope - ✔️✔️The scope of an audit defines
the specific concerns to be addressed with an audit.
The scope of an audit can be general or limited
The audit scope is closely tied to the audit objectives.
Components of an audit report: d) Issue Oriented Findings: Where there are consistent
findings attributable to a specific CPT/HCPCS Level II code, or a particular provider, -
✔️✔️it is appropriate to report these findings in an issue-oriented format
Understanding how to develop and draft a well-structured and detailed audit report is -
✔️✔️a critical skill for any competent auditor.
The audit report should identify the key findings and present the analysis, rationale and
recommendations in a format that is - ✔️✔️easy for the auditee to read, understand
and apply
Components of the Audit Report - ✔️✔️Background
Summary of Audit Findings
Standard of Review
Issue Oriented Findings
Discussion
Recommendations
Report attachments
Resources/Reference List
Components of the Audit Report (A) Background - ✔️✔️This is the introductory section
of the audit report: Identify the following
, identity of the entity,
physician(s) being audited
objectives
type and scope of the audit
identity and qualifications of the auditor
Component of the Audit Report (a) background: Objectives - ✔️✔️The objective of the
audit may be
to assess compliance with a pending change in a payer's documentation standards
to assess the effectiveness of prior education efforts
to identify and assess potential pos-payment risk,
or to determine the veracity of compliance concerns reported by an employee, patient or
payer.
What ensures that an audit is focused and accomplishes its intended result? -
✔️✔️Understand what is to be learned or determined in the audit,
and maintaining a focus on those objectives throughout the course
Compliance audits as part of an integrity agreement or monitoring program, may be
commissioned by, or is performed on behalf of an external entity.
There are several types of compliance audits: - ✔️✔️Retrospective
and prospective
Retrospective audits - ✔️✔️evaluate whether services that were previously reported to
a particular carrier were reported appropriately, and are consistent with that carrier's
binding rules.
Prospective Audits - ✔️✔️intercept claims coded prior to reporting to ensure the coding
and associated documentation is compliant with binding carrier standards.
Another type of prospective audit involves analysis of current claims against a pending -
- but not yet implemented -- standard, to determine if changes are necessary to
maintain compliance.
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