Audit Scoring (Audit Manager Professional and Consulting)

This article will go over Audit Scoring in AM Professional and Consulting.

Table of Contents

• Standard Scoring Methodology
  • Provider/Coder Detail Report
  • Project Summary Report
  • Project Detail Report
  • Practice Accuracy Scores
  • Overall Accuracy Score Settings
  • Accuracy Rate Differences between the Project Detail Report and the Project Summary report
• Weighted Scoring
  • Which reports display weighted scoring?

Standard Scoring Methodology

Every code gets 1 point if correct and zero points if over-coded, under-coded, incorrect, additional, or wrong category. The calculation method for each code group is, the total number of correct codes, divided by total possible codes within that code group. 

For the Overall Accuracy Score, the calculation is the same (total correct codes divided by total possible codes), but across all code groups included in the Overall Accuracy Score setting (see Overall Accuracy Score Settings for more info).
Note: This calculation will round to the nearest whole percentage.

Provider/Coder Detail Report

File Type Availability: PDF, Word

Individual code groups and Overall Provider/Coder accuracy scores: Every code gets 1 point if correct and zero points if incorrect/additional/wrong category. For example: 11 total E/M codes. 5 correct, 6 incorrect:  5/11=.45 or 45%. This calculation is the same for all other code groups as well.
 

Project Summary Report

File Type Availability: Excel Only

The Project Summary Report provides both individual code group accuracy rates, and overall accuracy rates for each provider, and all providers combined for a given project. See the calculation methodology under the Standard Scoring Methodology section above.
Note: The overall accuracy score is NOT an average of all code accuracy rates, but is a percentage of the total number of correct codes, divided by the total number of codes across all included code groups.

See the example below:

• Bates: total correct 2 (0 EM + 1 ICD-10 + 1 CPT + 0 Mod) divided by total of all codes 6 (1 EM + 2 ICD-10 + 2 CPT + 1 Mod) = 2/6 = 33%
• Total: total correct 14 (4 EM + 3 -ICD10 + 6 CPT + 1 mod) divided by the total sample of each code 25 ( 7 EM + 6 ICD-10 + 9 CPT + 3 mod). 14/25 = 56%

Project Detail Report

File Type Availability: PDF, Word

Individual and Overall Provider/Coder accuracy scores: Similar to the Provider/Coder Detail Report example above, but also gives a full breakdown of each encounter audited within the project.

Practice Accuracy Scores

The practice and provider overall scores (seen below in the red box) are calculated in the same way that the overall accuracy on the Project Summary Reports. Total correct codes divided by total possible codes within that code group. These scores are available on both the Provider/Coder Detail report, as well as the Project Detail Report.

Overall Accuracy Score Settings

You can choose which codes to include in the overall accuracy rate in the 'Assign Report Parameters' section within the Project Guideline Settings. Under Project Details Report – Practice Score, check each code type you want to include in the overall accuracy score.

Accuracy Rate Differences between the Project Detail Report and the Project Summary report

For the Project Detail Report users can choose which codes to include in the overall accuracy rate (this is not possible in the Project Summary Report). Users can choose which codes to include in the overall accuracy rate in the REPORTING PARAMETERS within the AUDIT GUIDELINES. Under Project Details Report – Practice Score, check each code type you want to include in the overall accuracy score.

For the Project Summary Report, if you have turned off modifiers for the code summaries, as shown on the left above, then modifiers are not even included in the Project Summary Report. But, let’s say you want to include the modifier counts for educational purposes, but, don’t want modifiers to factor into the Overall Accuracy score, then you want to include them on the left.  As stated above, unchecking modifiers from the Project Details Report – Practice Score will exclude modifiers from the overall accuracy on the Project Detail Report, but not the Project Summary Report.

That said, you CAN manually modify which codes (ie. only EM & CPT) are counted in the overall accuracy for the project summary score by changing the formula within the overall accuracy cell of the spreadsheet. (see below)

You can ignore all of the formula before ROUND, it’s a command saying if all the cells are zero, then the overall accuracy should be a dash. BUT…everything to the right of ROUND is indicating which codes are included. You can modify the formula in the first cell by deleting those cells you don’t want to include, then drag the formula down for all providers. In the example below, if you want to remove ICD-10 and modifiers from the overall score, you need to delete any references to cells in those categories. For example, the columns involved with ICD-10 are R,S,T and columns for modifiers are AD, AE, AF. To remove those, you would delete any cell references for AD, AE, AF.

Weighted Scoring

Weighted scoring allows you to assign fractions of a point for each coding level.  See screenshot below for an example.

• Correct – 1pt
• Under coded 1 level - .5 pts
• Under coded 2 levels = .25 pts
• Under coded 3 or 4 levels = 0 pts
• Over coded 1-4 levels = 0 pts
• Additional = 0 pts
  

Which reports display weighted scoring?

• Provider Detailed Report

  • Weighted scoring is listed on the first page for all code types

• Project Detailed Report

  • Weighted scoring is listed on the first page for all code types
  • Practice & Provider scores are determined by Audit Guidelines settings: Report Parameters > Project Details Report - Practice score settings determine which code sets are included in score

• Project Summary Report

  • Weighted scoring is listed on the first page for all code types