Audit Worksheet Overview

Audit Manager+ introduces the Audit Worksheet, a streamlined tool designed to support the unique needs of medical auditing and coding professionals.

With built-in flexibility and precision, the Audit Worksheet accommodates a wide range of claim types, including professional, facility, dental, HCC, DRG, and APC. Its customizable interface removes unnecessary complexity, helping auditors perform accurate and efficient reviews with ease and focus.

Each project in Audit Manager+ can be customised to define which data elements are displayed and which ones require auditor validation. These data elements fall into two categories: informational elements, which offer context to support the audit process, and actionable elements, which auditors must review and correct if found to be inaccurate. The navigation and functionality are the same in both the Enterprise and Multi-Account versions. 

Follow these steps to start working with the Audit Worksheet:

• Navigate to the Audit My Work Queue. The Audit Work Queue page will be displayed. 
• Select the desired Auditee hyperlink to open the DOS Work Queue page.
• Click Resume hyperlink from the Action field to open the Audit Worksheet.
• Each column in the Audit Worksheet serves a unique purpose and function, highlighting its specific role in supporting the audit process.
  • A Data Element is a specific, identifiable piece of information within an audit record that is relevant to the auditing process. It may represent clinical, coding, financial, or demographic data such as diagnosis codes, procedure codes, service dates, provider identifiers, or payment amounts. For more details, see Data Elements. In audit workflows, data elements typically fall into two categories: 
    • Informational: Displayed to provide context or support audit decisions but not directly modified.
    • Actionable: Require auditor review to determine correctness and, if needed, initiate corrections.
  • Reported – Auditee needs to enter the reported details of the desired data element.
  • Audited – Audited data needs to be entered if there are any changes to the reported data.
  • Possible Points – The possible points for each audit item enable users to better evaluate scoring criteria.
  • Deduction Point– The deduction points in the Audit Worksheet display the evaluation result based on the review of the claim.
  • Error Description – The claim error description shows details about any errors identified in the encounter. This field helps the user to understand the nature of the error for corrective action. These error messages include the data element name, making it easier to identify issues within the worksheet and reports.

Audit Worksheet Sections

The Audit Worksheet has been divided into the following sections:

• Claim Header – It includes general information of the patient, such as patient name, ID, DOB, medical record number, patient control number, billing provider NPI, and so on. Refer to the Claim Header for more details.
• Service Line – Each Service Line includes the details of services provided to the patient, such as the date of service, place of service, procedure code, modifiers, units, charges, and paid. Diagnosis codes can be linked to each service line. Up to 99 lines can be associated with a single encounter. Refer to the Service Line Information for more details.
• Chart Result - This section covers documentation and coding details for the entire encounter. Auditors can review items like consents and signatures, record errors, complete checklists, and assign a Master Outcome. It also displays a summary of points, deductions, and accuracy. Refer to the Chart Result for more details.
• Audit Results - This section compiles all findings across the patient’s Dates of Service. It shows total possible points, deductions, and the overall accuracy percentage. Users can also select errors, complete checklists, and assign a Master Outcome to finalize the audit review. Refer to the Audit Result for more details.

Saving & Submitting DOS

Once all the required information carefully filled, review the added information thoroughly before saving or submitting the DOS.

• Run Edit to automatically validate the reported and audited data, highlighting any alerts next to the data elements that require corrections. Make the necessary changes and complete the DOS.
• Review and address all alerts before proceeding to save or submit the DOS.
• Once all the patient information and other DOS details are updated, click on the Save & Submit. Auditee can also choose the following option using the Save & Submit button:
  • The Save option allows the auditee to save the entered details and complete the DOS at a later date and time.
  • The Complete Claim option allows the auditee to save the entered details and mark the DOS as completed.
• If there are multiple DOS available, the auditee can complete the process following the above steps.

Note:

• • In Run Edit, a Not Supported value in Audited Data indicates that the field is either null or blank. No edits should be applied when the Audited Data value is Not Supported.
  • Auditors can assign up to three auditees per patient record, ensuring department-specific access to relevant patient information and maintaining data integrity across roles.

Additional Functionality 

Users can click on the icon in the top right corner of the screen and access the following functionalities, as needed:

• Add Auditee: The Add Auditee allows you to select a new auditee for the DOS. You can also click to add a new auditee. 
  • When new auditees are added, existing reported values are copied for consistency, and further edits do not affect others.
• Bulk Add Claim Data: Enables users to import multiple claims at once using a bulk upload process. This is useful for handling large volumes of data efficiently. The info icon typically provides file format or upload guidance.
• Data Request: The Data Request allows users to request additional data or information needed for completing an audit.
• Internal Notes: The Internal Notes allow the addition of information specific to the particular DOS. You can also add multiple notes if needed.
• Transaction History: Provides users with a detailed record of all transactions and activities related to a specific audit.
• Preview Data/Report: Allows users to generate a preview of the compiled audit data, reports, or print. This allows us to generate a printable version of DOS.

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