Configuration of the QA Acceptance Alerts

Enable QA Features

Audit Manager Professional, Consulting, and Audit Manager+ have two options for implementing QA for an individual user: 1) Method one is to flag a percentage of the encounters audited; 2) Method two is to identify encounters with certain auditing results. These options are selected in the user's record. 

The first method, selection of a percentage of edits, is simple in that Audit Manager+ will randomly divert encounters to the QA queue, and the specified percentage of encounters will be audited.

The second method has four options: 1) overcoded, 2) undercoded, 3) addition, and 4) incorrect.   The over- and under-coded alerts only apply to E/M codes.  The addition and incorrect alerts are for any code. The overcoded alert is raised when the Audited code is a lower level than the Reported code. The undercoded alert is raised when the Audited code is a higher level than the Reported code. The addition alert is raised when there is no reported code, but there is an Audited code.  The incorrect alert applies when the Audited code is different than the Reported code.

The QA processes within Audit Manager+ allow leaders and managers to determine, for each user, which auditing results they want to have flagged for a second review. The ease and flexibility allow managers to adjust QA settings as the individual user gains experience and accuracy in auditing. 

The following steps enable QA Alert Flags:

• Log in to the Healthicity Audit Manager.
• Navigate to the Admin Manage Users. A Manage User screen will be displayed with list of licensed users. 

• To enable the QA Acceptance Alerts for existing users, select the desired user or click the Edit icon in the Action column. An Edit User window will be displayed.
• For new users, this selection can be done when the user is initially set up.
• The user's role must be selected before the QA options are enabled.

Note:  The QA features need to be enabled for both the auditors and individuals performing QA reviews.

• Enable the QA Acceptance Alerts and choose one of the desired alert types from the drop-down:

• A Percentage of all DOS: The system will randomly select a defined percentage of Dates of Service (DOS) for QA review, as specified in the auditor's settings. This feature allows user to adjust QA review based on the auditor's performance.
  • The user can adjust the percentage using a percentage dial.

• Only selected Error Types: The system will display real-time alerts for the QA reviewer, when the audited DOS meets one of the following criteria:
  • Over-coded: When an auditor identifies over-coding within a Date of Service (DOS), a red alert will be raised, ensuring immediate attention and correction.
  • Under-coding: When under-coding is identified within a Date of Service (DOS), a yellow alert will be raised for prompt review.
  • Additional: When additional codes are added to a DOS, a green alert will be displayed for verification and validation.
  • Incorrect: When an auditor finds incorrect codes, an orange alert will be raised to prevent errors and ensure accurate coding.

• Once the desired options are selected, click on the Save.

Workflow of QA Features

Perform the Audit

• Navigate to the Audit My Work Queue Audit Work Queue. The Audit Work Queue window will be displayed.
• Select the desired task, and the Date of Service Work Queue List window will be displayed.
• Choose the desired task and click on the Resume/Start Audit hyperlink in the Action field. The Audit Box window will appear to complete the DOS. 
• Complete all the DOS and click on the Save & Submit, and select the Complete Claim button to mark DOS as completed.
• Click on Close Send to QA from the Audit Work Queue list. The QA alert flag will be reflected only for QA in the QA work Queue window, according to the alert configuration, if any mismatch or correction is required. 

• For additional details, see the video Configuration of QA Acceptance Alert Flag.

Clear QA Acceptance Alert Flag

To review the flagged encounter and clear the QA Flag, follow these steps:

• Log in to the Healthicity Audit Manager with the QA Reviewer credentials.

• Navigate to the Audit View My QA Audits or navigate to the Audit My Work Queue QA Work Queue. The QA Work Queue window will be displayed.
• Click on the desired provider name. The DOS Work Queue window will be displayed to review the DOS.
• To proceed, click on the Resume/Start Audit hyperlink in the Action field. This action will display the Audit Box window.
• Go to the desired code area where corrections are required. Make a desired correction and click on the Run Edit button.
• Once all necessary changes are made, click on Save & Submit to save the DOS details.
• Click Complete, then close the window. This will clear the QA alert flag.

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