Auditing queries

When auditing queries from both a coder and CDI , do you base the accuracy rate on whether or not there is a modification to the query? In my experience, the query maybe compliantly written and just because you might tell the coder or CDS to add one more thing on there should not count towards their accuracy rate because at the end of the day its still a compliant query. I could not find anything in writing that says that an edit to query should count against the person and that this is best practices …. how are other organizations performing query audits and calculating feedback into the accuracy rate towards that person? 

Comments

  • I'm a bit confused by your question.  Are you referring to DRG mismatch scenarios or something else?  It sounds like your referring to the text of a query and differences between what a CDS versus a Coder would put down?  Can you describe the audit process you're referring too?  Thank you.
  • Hello, 
    I am talking about auditing a query for compliance ensuring that it is a compliant query whether the query is generated by a coder and auditing their query or auditing the CDS and their query. When you look at a query to ensure the query has the appropriate options, no leading questions, has the  clinical indicators, risks, treatment, etc. 
  • If you are auditing for a compliant query and the query is compliant (remember all reasonable choices should be provided and only reasonable choices) then the query is compliant.

    If you want to take it to another level and determine if the query is presented in a manner that a Provider should be able to easily understand, etc... then that's a different ballgame and should be separate from "is this a compliant query".

    Everyone writes queries differently. I will say that Organizations are best served to ask the same questions of the same providers the same way every time they ask. For example your complication queries should contain the exact same verbiage regardless of sender, etc..

    Jeff


  • jwmorris1 said:

    If you are auditing for a compliant query and the query is compliant (remember all reasonable choices should be provided and only reasonable choices) then the query is compliant.

    If you want to take it to another level and determine if the query is presented in a manner that a Provider should be able to easily understand, etc... then that's a different ballgame and should be separate from "is this a compliant query".

    Everyone writes queries differently. I will say that Organizations are best served to ask the same questions of the same providers the same way every time they ask. For example your complication queries should contain the exact same verbiage regardless of sender, etc..

    Jeff


    Second that. Bingo!
  • jwmorris1 said:

    If you are auditing for a compliant query and the query is compliant (remember all reasonable choices should be provided and only reasonable choices) then the query is compliant.

    If you want to take it to another level and determine if the query is presented in a manner that a Provider should be able to easily understand, etc... then that's a different ballgame and should be separate from "is this a compliant query".

    Everyone writes queries differently. I will say that Organizations are best served to ask the same questions of the same providers the same way every time they ask. For example your complication queries should contain the exact same verbiage regardless of sender, etc..

    Jeff


    Third that...very well stated by Jeff.  I’d modify each query for the particular circumstances, but fundamental approach as to query formulation should be ‘as consistent’ as feasible.
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