MDaudit™ was developed with a flexible design to adapt the software to meet each organization's policies and procedures.

Features

Data Integration   Audit Practices   Audit Cases   Audit Case Profile   Risk-Based Audit Frequency   Audit Findings   Audit Package of Reports   Chart Requests & Tracking   Flexible Reporting · Data Integration   TheMDaudit™ database is structured to support the data elements required to produce a 1500 claim form. To date, the software has been integrated with practice management systems, data warehouse applications, decision support systems, front-end code scrubber applications and database management systems. At one client, physicians are members of a Physician's Organization with a centralized billing office that uses IDX® TES Transaction Editing System and IDX® BAR Billing and Accounts Receivable system. Additionally, some physicians are also employed by the hospital. Services rendered while working as a hospital employee are billing out of the hospital's billing system. For this client, MDaudit™ was integrated with TES for prospective auditing, as well as BAR and the hospital system for retrospective reviews.

Audit Practices   Within MDaudit™, Practices are the basic entity audited. A Practice is configured by the compliance office to contain one or more divisions either within or across departments. For example, your Surgical Practice may be audited in one large audit or may be audited separately in smaller division-based audits (e.g., Pediatrics, Vascular, Cardiac, etc.). Each audit has activity initiation and completion date information, an audit period date range (corresponding to date of service), primary auditor, and current audit status (e.g., "In-Progress" or "Completed"). Auditors may be assigned to the unique divisions within the Audit to assist with labor dispersion.

Audit Cases   MDaudit™ constructs audit cases from all services provided by a given provider to a given patient on a single date of service. MDaudit™ automatically selects a set of Audit Cases based on a flexible Audit Case Profile.

Audit Case Profile   The Audit Case Profile defines how many and what types of services will be selected (assigned) by MDaudit™'s Audit Case Assign function. Services may be selected based on Prior Audit findings, Top Volume billed, Top Dollar billed, insurance specific, CPT/Diagnosis/Modifier ranges or groups, locations (Inpatient/Outpatient) and CPT categories (E&M, Procedures, Consultations).

Risk-Based Provider Audit Frequency   Users can create audits for all providers within a given practice that have billing activity within a certain date of service range. MDaudit™ also contains Risk-Based audit frequency functionality, which systematically devotes more compliance attention on those providers with poor audit performance. At the conclusion of the audit, MDaudit™ uses the provider's score to determine when they are due for their next audit. For example, a provider who failed their audit could be moved from an annual audit frequency to a quarterly audit frequency. If they fail their quarterly audit, they could be moved from a quarterly retrospective audit to a quarterly prospective audit. Similarly, a provider with a perfect audit score could be moved to a less frequent audit schedule (annual to bi-annual).

Audit Findings   Audit Findings are the recorded observations made by your auditors related to the procedures, modifiers, and diagnoses billed by the practice. Each Audit Finding has a profile indicating a penalty weight assessed to the audit along with classification information that helps categorize the audit finding. Comments may be associated with the audit finding to explain the circumstances of the problems identified by the auditor. Each Audit Finding can be associated with a set of standardized comments, selectable by the auditor. Alternately, the auditor may utilize the Audit Phrase feature to build a dynamic comment from free-standing comment phrases. These features increase efficiency and standardization in how information is presented to your practices.

Audit Package   The Audit Package is a set of reports that can be run to publish a comprehensive package to communicate the results of the audit to the practice that was audited. The Audit Package contains the following report sections:   Title Page   Table of Contents   Procedure Coding Summary   Diagnosis Coding Summary   Audit Summary   Provider Audit Summary   Audit Finding Detail Additionally, a Provider Finding Detail report creates a detailed report that can be disbursed to the individual providers audited.

Chart Requests   MDaudit™ can help you manage your chart request process. You may be struggling with a mix of documentation sources, including Electronic Medical Records and paper charts, which can be located in several different areas. With MDaudit™, you can generate a report which lists the charts needed for one or more audits (i.e., Patient, Provider, Date of Service, Procedures). This can be printed or exported to Excel. Additionally, you can track and manage the chart request status of each chart, and easily determine which requests are outstanding, partially received, or complete.

Flexible Reporting   Many standard reports are included with the MDaudit™ system. Each report permits a wide assortment of report filters to be applied, addressing the varied circumstances related to how the information from these reports is utilized. MDaudit™ supports a separate SQL-based environment for Ad-Hoc reporting and querying to complement the standard reports distributed in the system. Users with a knowledge of the SQL-based query tools such as Crystal Reports can utilize this feature to develop customized reporting capabilities.

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IDX® and BAR™ are registered trademarks of IDX Systems Corporation, Burlington, Vermont