Auditing the coding and abstracting of documents
Techniques for implementing Quality Assurance of the process of coding medical documents are disclosed. An audit of a coding process for a medical document is initiated by selecting and setting audit parameters. Using the selected parameters, a sample batch of coded documents is obtained from a universe of coded documents. The sample batch of coded documents is presented to auditor(s), and the auditor(s) provide corrections, which are recorded, and a score for each correction is calculated. A sample score, based on the corrections, is calculated in a manner that tracks to subjective auditor assessments of the process quality as being acceptable, marginally acceptable, or unacceptable, and which sample score accounts for the individual auditor subjectivity and an error.
1. A method comprising:
receiving, by one or more processors and via a graphical user interface (GUI) wizard, audit parameters for selecting a document universe;
providing, by the one or more processors via the GUI wizard and based on the audit parameters, a plurality of medical documents coded by a coder and selected using a selected document universe;
receiving, by the one or more processors via the GUI wizard, a plurality of corrections to the plurality of medical documents;
forming, by the one or more processors, a plurality of audited medical documents using the plurality of corrections to the plurality of medical documents;
determining, by the one or more processors as the plurality of corrections is received, a document score for each of the plurality of audited medical documents, each document score based on one or more corresponding corrections of the plurality of corrections and predefined weights assigned to at least one of diagnosis codes, procedure codes, or level of service codes of a respective audited medical document of the plurality of audited medical documents, wherein the document score changes as the one or more corresponding corrections of the plurality of corrections are received;
determining, by the one or more processors, a sample score for the plurality of audited medical documents based on the document score; and
causing, by the one or more processors display via a GUI of a graphical analysis comprising the sample score, and at least one of an upper control limit, a lower control limit, or a previously determined sample score of audited medical documents coded by the coder.
2. The method of claim 1 , further comprising periodically determining, by the one or more processors, an acceptability of the sample score based on an empirical test.
3. The method of claim 1 , wherein determining the document score comprises:
determining a number of units associated with a procedure code; and
determining a number of links associated with the procedure code.
4. The method of claim 1 , wherein the sample score is determined by:
designating, by the one or more processors, at least one of the upper control limit and the lower control limit based on an expected auditor error level; and
comparing, by the one or more processors, the sample score against the at least one of the upper control limit and the lower control limit to determine an acceptability of the sample score.
5. The method of claim 1 , further comprising tracking, by the one or more processors, a measure of variance in the sample score over time based on periodically performing an empirical test.
6. The method of claim 1 , further comprising comparing the plurality of corrections to another plurality of corrections by another auditor.
7. The method of claim 1 , further comprising adjusting, by the one or more processors, a defect level based on an expected subjectivity and error of an auditor.
8. The method of claim 1 , further comprising creating and exporting one or more of: a code modality report, an automated coding system analysis, a human coder analysis, an auditor changes report, a transcription report, or a chart analysis comparing various audited coders over time.
9. The method of claim 1 , wherein the GUI comprises an audit window divided into panels and dialog boxes configured to be displayed, hidden or repositioned and resized relative to other panels displayed on the GUI.
10. A system configured to evaluate coded medical documents, the system comprising memory and one or more processors communicatively coupled to the memory, the one or more processors configured to:
receive, via a graphical user interface (GUI) wizard, audit parameters for selecting a document universe;
provide, via the GUI wizard and based on the audit parameters, a plurality of medical documents coded by a coder and selected using a selected document universe;
receive, via the GUI wizard, a plurality of corrections to the plurality of medical documents;
record the plurality of corrections to form a plurality of audited medical documents;
determine, as the plurality of corrections is received, a document score for each of the plurality of audited medical documents, each document score based on one or more corresponding corrections of the plurality of corrections and predefined weights assigned to at least one of diagnosis codes, procedure codes, or level of service codes of a respective audited medical document of the plurality of audited medical documents, wherein the document score changes as the one or more corresponding corrections of the plurality of corrections are received;
determine a sample score for the plurality of audited medical documents based on the document score; and
cause display via a GUI of a graphical analysis comprising the sample score and at least one of an upper control limit, a lower control limit, or a previously determined sample score of audited medical documents coded by the coder.
11. The system of claim 10 , wherein the one or more processors are further configured to determine whether the diagnosis codes are associated with an adverse consequence.
12. The system of claim 10 , wherein the one or more processors are further configured to track a measure of variance in the sample score over time based on periodically performing an empirical test.
13. The system of claim 10 , wherein the one or more processors are further configured to compare the plurality of corrections to another plurality of corrections by another auditor.
14. The system of claim 10 , wherein the one or more processors are further configured to adjust a defect level based on an expected subjectivity and error of an auditor.
15. A non-transitory computer readable storage medium encoded with instructions executable by one or more processors that when executed instruct the one or more processors to:
receive, via a graphical user interface (GUI) wizard, audit parameters for selecting a document universe;
provide, via the GUI wizard and based on the audit parameters, a plurality of medical documents coded by a coder and selected using a selected document universe;
receive, via the GUI wizard, a plurality of corrections to the plurality of medical documents;
record the plurality of corrections to the plurality of medical documents to form a plurality of audited medical documents;
determine, as the plurality of corrections is received, a document score for each of the plurality of audited medical documents, each document score based on one or more corresponding corrections of the plurality of corrections and predefined weights assigned to at least one of diagnosis codes, procedure codes, or level of service codes of a respective audited medical document of the plurality of audited medical documents, wherein the document score changes as the one or more corresponding corrections of the plurality of corrections are received;
determine a sample score for the plurality of audited medical documents based on the document score; and
cause display via a GUI of a graphical analysis comprising the sample score, and at least one of an upper control limit, a lower control limit, or a previously determined sample score of audited medical documents coded by the coder.
16. The non-transitory computer readable storage medium of claim 15 , wherein the instructions further instruct the one or more processors to track a measure of variance in the sample score over time based on periodically performing an empirical test.
17. The non-transitory computer readable storage medium of claim 15 , wherein the instructions further instruct the one or more processors to adjust a defect level based on an expected subjectivity and error of an auditor.