5 Tips to Provide Effective Post-Audit Education
You’ve identified high-risk areas based on previous audits or the OIG Work Plan. Or perhaps you decided to audit new service lines or high-dollar as well as high-volume procedures. You’ve selected a random sample of claims. You’ve audited those claims to determine coding and documentation accuracy. Now what?
It’s time to provide effective post-audit education. You need to let others (e.g., physicians, executive leaders, coders, and CDI specialists) know what you found, both the good and the bad. In fact, it’s probably safe to say that without this last critical step in the auditing process, most of your work would have been in vain. If people don’t know what the audit revealed, how can they possibly take steps to improve compliance?
Still, providing this education requires a thoughtful approach to maximize effectiveness. Consider the following five tips:
1. Know your audience. Not everyone will want or need the same information. For example, a CFO may only want to see high-level trends and financial impact of certain MS-DRGs while coders may need a deeper dive into specific ICD-10-CM and ICD-10-PCS codes.
It’s important to tailor information during post-audit educational sessions so people don’t become inundated with information that isn’t relevant to their job. You want them to retain critical details—not tune you out or assume that none of it applies to them. In most cases, you’ll know what information and reports to discuss during post-audit educational sessions. However, asking attendees for input in advance can also be a helpful strategy. That’s because they may request data you hadn’t anticipated—data that could lead to interesting and productive conversations.
2. Remind people of the purpose of the audit. Set the tone of the post-audit education by reminding people that your intention is not to be punitive but rather to proactively prevent compliance risk. Emphasize that you’re on their side and that everyone works together as a team to ensure compliant documentation, coding, and billing. Also conclude the educational session with this statement to remind people of your common goals so they walk away with a sense of optimism.
3. Emphasize strengths, stay positive. Everyone likes positive feedback. That’s why it’s important to set the stage with positivity, for example, an area in which compliance improved or an area of consistently high compliance. If you dive directly into examples of noncompliance, you may actually turn people against you and make them less receptive to what you’re saying.
For example, begin your post-audit education for physicians by saying, ‘The good news is that we have a 98% query response rate. Unfortunately, we’re still reporting unspecified codes. Let’s explore why that’s happening.’ Begin your post-audit education for coders by saying, ‘The good news that our clinically valid MCC capture rate has improved by 10% since the last audit. Unfortunately, we’re still missing these three MCCs. This gives us an opportunity focus our improvement efforts.’
4. Educate one-on-one, when necessary. Sometimes post-audit education is effective on a large-group level, but sometimes it needs to be one-on-one to maximize effectiveness.
For example, an audit may reveal that one coder in particular—not the department at large—struggles to accurately report sepsis. In this case, taking the time to educate this person individually is most effective. The same is true for a physician who consistently under-documents kidney failure or a CDI specialist who frequently poses leading queries.
Come prepared with specific examples to support your findings as well as official coding guidelines and other references that explain your rationale. When educating physicians or non-physician practitioners, you may also want to bring a bell curve report so they can see how they are coding relative to their peers. Most importantly, try not to point the finger. For example, you could say ‘This code isn’t supported by documentation’ as opposed to ‘You didn’t document this correctly.’
5. Encourage questions and open discussion. A good auditor will invite—not discourage—questions. Open dialogue is how people learn and exchange ideas. It’s also how you build trust—a critical element between auditors and those being audited.
For more information about MRA’s comprehensive auditing services, including targeted post-audit education, visit https://www.mrahis.com/auditing-and-compliance/.
For more information regarding coder education, visit: https://www.ahima.org/education-events/education-by-product/