Audit Scoring (Audit Manager Professional and Consulting)

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

Standard Scoring

Audit Manager scoring methodology is every code gets 1 point if correct and zero points if over-coded, under-coded, incorrect, additional, or wrong category

Provider Detail Report

Individual code accuracy rate: Every code gets 1 point if correct and zero points if incorrect/additional/wrong category.  For example: 11 total EM codes. 5 correct, 6 incorrect:  5/11 = 45%.  This calculation is the same for CPT, Modifiers, and ICD-10 codes.

Project Summary Report

The project Summary report provides both code accuracy rates and overall accuracy rates for each provider and all providers combined.

Individual Code Accuracy Rates: Every code gets 1 point if correct and zero points if incorrect/additional/wrong category. (same as Provider Detail Report)

Project Summary Report - Overall Accuracy: The provider and total overall accuracy are calculated by adding up all correct codes then dividing by the total code count. It is NOT an average of all code accuracy rates.

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.

For 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

Individual code scores: Same as other two reports above.

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.

You 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.

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 on first page for all code types

Project Detailed Report

• Weighted scoring on 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 on first page for all code types