Audit Manager+ Quick Start Guide – Healthicity Support

This guide walks you through how to set up your first audit in Audit Manager+.

This article will be broken up into the following sections. Click on a section to jump there.

Overview
Create or Review an Audit Guideline
Configure General Audit Information
Select and Configure Data Elements
Understand & Use Metrics
Use Checklists
Understand Scoring
How Metrics and Checklists Work Together
Where Scoring Appears in Reporting
Data Element Scoring (Header & Line)
See these Settings in Action
Audit Manager+ Key Terms and Definitions

Overview

In this section we will cover:

How audits are structured (the big picture)
How to configure Audit Guidelines (the setup)
How scoring works (what the setup produces)
How those settings appear during an audit (what you’ll see in practice)

How Audit Manager+ Works (Big Picture)

Audit Manager+ uses a rules-based structure to ensure audits are consistent, repeatable, and defensible.

Audit Guidelines define what you are auditing
Data Elements, Metrics, and Checklists define how audits are reviewed and scored
The Audit Worksheet uses these rules for when you conduct the audit

Before getting started, it’s helpful to know the meaning of a few key terms:

Audit Guideline
A reusable audit template that defines how an audit is structured. It controls the claim type, what appears on the worksheet, who is audited (provider/coder/etc.), and how scoring/checklists behave.

Data Element
An individual field included in an audit, representing information from a claim or medical record (e.g., CPT, Diagnosis, Modifier, Patient Name, DOB, DOS, MRN). Data Elements are displayed on the Audit Worksheet and can be informational, reviewed, and/or scored.

Metric
The business rule that tells the system what to do: score the element, apply errors, or trigger a checklist. Metrics can apply to a Data Element or the entire chart.

Because everything relies on the Audit Guideline, that’s always the starting point.

Create or Review an Audit Guideline

Think of Audit Guidelines as reusable audit templates. You set them up once and use them repeatedly to create new audits.

Audit Guidelines control:

What type of claims are audited
Which data fields appear on the audit worksheet
Who is being audited (provider, coder, etc.)
How errors, points, and checklists are applied

Where to Find Audit Guidelines

Enterprise/Professional Clients: Admin → Manage Audit Settings → Audit Guidelines
Consulting (global guidelines): Admin → Manage Settings → Audit Guidelines
Consulting (individual sub-client guidelines): Client → Select Sub-Client → Client Settings → Audit Guidelines

From here, you can either edit a pre-loaded guideline or create a new one.

Configure General Audit Information

Once on the Audit Guidelines page, click on an existing guideline name, or click the Actions button to Add a new guideline. WIthin the Audit Guideline you will start on the General Information tab.

Key Fields to Complete

Guideline Name - Use a short, clear description of the audit scope.
- Examples: E/M Office Visits, Inpatient DRG, Dental Coding Review, etc.
Type of Claims - Select the claim type you will audit. Options depend on your enabled modules:
Note: You may have multiple guidelines for the same claim type if the audit focus differs.
- Professional
- Facility
- Dental
Default Audit Guideline (optional) - Enable this if the audit should use the default guideline for this type of claim.
These are the only settings you should need to adjust in the General Information tab, unless you’re performing an HCC Risk Adjustment Audit, or need to associate a chart-level metric to trigger a chart checklist or error.
Next, we’ll define the fields you want to include in your audit.

Select and Configure Data Elements

Data Elements determine what appears on the Audit Worksheet and what gets reviewed during an audit.
Go to the Data Elements tab.

What Are Data Elements?
Data Elements are the individual fields reviewed during an audit. They are divided into two main types:

Header Elements - Patient-level information (e.g., Name, MRN, DOB, Payer, Diagnosis)
Line Elements - Service-level information (e.g., DOS, CPT, Modifiers, Units)

How to Select Data Elements

Toggle View All to see all available elements
Check the box next to elements you want included

Data Elements can be repurposed. For example, ‘Accident State’ could be repurposed for state-specific regulations to be considered, or one of the six provider types could be used for an Administrator or Tech.

Assign Responsibility (Auditees)
For each Data Element, indicate who is responsible or to whom the error should be applied:

Provider
Coder
Generic (Departments, Facilities, AI, etc.)

You may assign multiple auditees to the same element or have different elements selected for each auditee type.

Rename Elements (Optional)
Use Custom Display Name to match internal terminology. These names appear in the audit worksheet and on reports.

Define the Purpose of Each Element

Each Data Element must be set as one of the following:

Display: Visible on the audit worksheet but not audited or scored. Used for reference only; no errors are tracked and no points are applied.
Review: Tracked and/or scored. Errors can be recorded for this data element. If a metric is applied, those errors will also contribute to scoring and overall accuracy.

Associate Metrics
For every reviewed element, you can assign a Metric to govern how you will track and report on that data element. Each Data Element has a default metric that can be edited as needed. Users can also create new metrics.

Metrics control:

Track or score
If scored, point values
Error types & deduction values
Whether a checklist is triggered

Only the line procedure code (CPT/HCPCS) data element can have multiple metrics. All other data elements can have only one metric associated with the data element at the same time in the same guideline.

If the purpose of a data element (Header Purpose) is set to Display, no metrics need to be added.

Understand & Use Metrics

Metrics are the rules engine behind tracking and scoring errors

Metrics define:

What is scored vs. tracked
If scored, how many points a data element is worth
What errors are available and how many points they deduct. Errors can have no point value.
Whether checklists are triggered

Metric Options

You can:

Use the default metric
Clone and modify an existing metric
Create a new metric
Important Note: Metric type must match the Data Element type (Header, Line, Chart), or scoring will not work.

Create or Edit a Metric

Navigate to the Metrics tab.

Enterprise/Professional: Admin → Manage Audit Settings → Audit Guidelines → Metrics
Consulting (global guidelines): Admin → Manage Settings → Audit Guidelines → Metrics
Consulting (sub-client guidelines): Client → Select Sub-Client → Client Settings → Audit Guidelines → Metrics

Click Actions → Add Metric to add a new metric. A Metric ID will be assigned by the system.

Select a Metric Type, whether it’s a Chart Metric or Data Element.
Note: It’s important to match the Data Element type (Header, Line, Facility, Prof, Dental, etc.) correctly, or the rules will not work.
Next, select a Data Element.
Note: If the metric type is chart, no data element is selected.
Choose a Deductions Category.
Enter a Metric Name.
For Line Procedure Code metrics, enter procedure codes that apply to this metric, separated by comma.
Select whether the metric should be scored or not.
Edit Possible Points if desired. (can be any value from 0.1 to 90)
If utilizing checklists, select the checklist(s) that should be triggered.
Enter an Effective Date.
Next, add Error Options. Click the plus icon to the right.
Name the error, then enter Deductions.
Note: Deductions of 0.0 will not score, but will track. Deductions can range from 0.1 point, up to 90 points, depending on the total number of the Possible Points setting. Deductions cannot be greater than the Possible Points for the metric.

Once your Data Elements and Metrics are configured, save the Audit Guideline.

Use Checklists

Checklists help the auditor determine if the Data Element is correct. Checklists evaluate documentation requirements for a specific code set (E/M, procedure, ICD-10), as well as chart documentation, compliance processes and regulatory requirements.

Navigate to the Checklists tab.

Enterprise/Professional clients: Admin → Manage Audit Settings → Audit Guidelines → Checklists
Consulting (global checklists): Admin → Manage Settings → Audit Guidelines → Checklists
Consulting (sub-client checklists): Client → Select Sub-Client → Client Settings → Audit Guidelines → Checklists

There are 65+ pre-loaded checklists (you can also create more). Most of the preloaded checklists are tied to specific code types, such as E/M visits and procedures. The checklist titles generally indicate the type of service they apply to, which makes it easier to identify the right checklist.

In addition, there are a few general chart documentation checklists that focus on compliant processes and how the chart is handled, such as attestations, consents, signatures, and incident-to scenarios.

Specific codes can automatically trigger checklists. For example, 99202-99215 can trigger the MDM checklist and the office outpatient checklist. You can also set up checklists at the chart level if the focus of the audit is a process, coding/documentation/regulatory requirement workflow, or targeted coding reviews.

There are 5 question types:

Date
Number
Picklist
Free form text
Yes/No/N/A – This question type can be scored. The default value is 1.0 point, but this can be adjusted from 0.1 point, up to 99 points.

Using Suggested Text with Checklist Questions

Yes, No, and N/A questions are typically the most intuitive, especially when scoring is involved. Control how auditor responses appear in comments for these question types using the Supporting Text.

For Date, Number, Picklist, and Free Form Text question types, you can use the placeholder [value] within the suggested text. This automatically inserts the auditor’s selected or entered value into the comment.

Example:
Checklist question (Number): Enter minutes for DOS
Suggested text: Minutes documented: [value]

If the auditor enters 25, the generated comment will read:
“Minutes documented: 25”

This gives your team full control over how audit findings and documentation comments are written.

Connecting Checklists to Audits

To trigger a checklist during an audit, it must be associated with a metric.

You can do this by either:

Adding the checklist to an existing metric, or
Creating a new metric for that checklist

Once the checklist is tied to a metric, it will appear as expected when the audit criteria are met.

Now you’ve reviewed and/or adjusted all the necessary settings for your Audit Guideline. Next, let’s review how all of these settings impact scoring.

Understand Scoring

If you choose to score the Data Elements, it’s helpful to understand the ins and outs of scoring.

Metrics define the rules, while scoring explains the outcome of those rules in practice. Before you run your first audit, let’s talk about how scoring actually works.

Audit Manager+ calculates scores using two separate but connected components:

Metric Points – applied to data elements (CPT, DRG, ICD-10, Revenue Codes, Modifiers) or to the chart (Incident-to, Cloning). Metric points classify the outcome of the audit of the data element.
Checklist Points – can be applied to a data element (documentation to support a code) or at the chart (chart quality documentation, focused-audit, or process adherence.

Each can contribute points, deductions, or just tracking results, —and not all of them have to be scored. Some clients score data element accuracy and use the checklists without points to track. For targeted audits, or compliance audits, some clients only score the checklist.

How Metrics and Checklists Work Together

Checklists are added to metrics, only to trigger them automatically. Only procedure code metrics can trigger based on the procedure codes.

Checklist scoring is controlled entirely inside the checklist.
Metrics and checklists can be linked to a Data Element or the overall chart.
- When both are used:
The metric applies its own points and deductions for that Data Element.
The checklist applies its own, separate points.
Both sets of points can contribute to the final audit results.

(Many clients do not include points with checklists, using them instead to review documentation requirements without contributing to the score.)

Where Scoring Appears in Reporting

In reporting, results are displayed clearly by source:

Metric errors and points appear in the Audit Summary Chart
Checklist errors and points appear under Checklist Details
Combined results (metrics + checklists) appear in Data Element Results

Data Element Scoring (Header & Line)

How Data Element Scoring Works

Each reviewed Data Element has:
- A possible point value
- One or more error options, each with a deduction value
By default:
- Possible Points = 1.0
- Each error = 1.0
  Note: Possible Point values can be adjusted between 0.1 point and 90 points)
These values are controlled by the Metric assigned to the element

Data Element Options

Display
- Appears on the audit worksheet
- It is not audited and therefore, does not affect the score
Review
- Can be audited (auditors can enter corrected values for reported information)
- Errors can be tracked and/or scored (scoring is determined by the Metric for the Data Element)

When Are Points Applied?

Points are not deducted automatically
The auditor must select an error
Once selected, the deduction applies immediately and autosaves

Chart Element Scoring

Chart Elements are typically used to evaluate:

Documentation quality
Targeted reviews
Compliance workflows
Signature, attestations, cloning, timeliness
Competency tracking (error patterns)

Chart Element Characteristics

Tracked or scored using Chart Metrics
Can:
- Add points
- Deduct points
- Or simply track issues without scoring
Often used when:
- The audit focus is compliance or process-based
- Coding accuracy is not the primary goal

See these Settings in Action

You’ve set up your first Audit Guideline and understand how metrics, checklists, and scoring work. Now, let’s take a look at how all the settings you configured earlier will show up in an audit.

Audit Guideline

When viewing Audit Projects, you can see the Audit Guideline that the project uses.

Data Elements & Metrics

When working on an audit in the Audit Worksheet, you can see the Data Elements that were configured in the Audit Guidelines, as well as any associated Metrics.

Header Data Elements appear at the top of the worksheet.

These are followed by Line Data Elements.

In the Chart Result section further down the page, any Chart Elements that were selected during setup will display.

If a Data Element was set as Display, it will only show in the Reported Data column. If a Data Element was set as Review, there will be an input field in the Audited Data column.

For Data Elements set as Review with a Metric associated, the point values configured during setup will display in the Possible Points column.

When you expand a Data Element by clicking on the blue circle on the right, the associated Metric will appear on the Errors tab, showing the Possible Points/Deduction Points and Deductions Categories you set when configuring the Metric.

For line procedure code Data Elements, the code entered into the Reported field will trigger the appropriate metric with its set point value, error options, and documentation checklist (optional)..

Checklists

If a specific procedure code is reported, it will automatically trigger an associated Checklist, which can be viewed by expanding the Data Element and toggling to the Checklist tab.

Audit Manager+ Key Terms and Definitions

Audit
A review of a sample of claims or visits for an auditee (Provider, Coder, Generic) to evaluate coding accuracy, documentation support, compliance workflows, or a targeted area of risk.

Audit Methodology
The “style” of audit you’re running. Most audits are either:

Code Accuracy Audits (review and correct specific codes/fields), or
Documentation/Process Audits (use checklists to evaluate documentation or workflow requirements),
Or a mix of both.

Audit Project
The container/folder where audits are organized (often aligned to a month, quarter, or audit plan). When a project is created, the appropriate Audit Guideline is associated with the project.

Audit Worksheet
The screen where the auditor performs the audit. It displays the fields (Data Elements), scoring rules (Metrics), and any triggered Checklists.

Audited Data
The value the auditor enters as the “correct” value during review (when a Data Element is configured as Review).

Auditee
The person or entity being evaluated or held responsible for a finding (e.g., Provider, Coder, or Generic such as department, facility, AI, etc.).

Chart
The overall medical record/encounter being audited. Some metrics and checklists can apply to the entire chart (not just individual codes/fields). Examples: Consent, signatures, attestations.

Chart Element
A chart-level item evaluated during an audit (e.g., signature present, consent obtained, incident-to compliance). These are often used for targeted/compliance audits.

Chart Metric
A metric (rule) applied to the entire chart rather than a specific field. Common for pass/fail style audits or overall documentation/process issues.

Checklist
A set of questions (audit elements) used to determine if the medical record meets coding and billing guidelines and/or compliance processes. Checklists can be triggered automatically for specific data element and/or procedure codes. Checklists can gather information needed for specific situations, such as immunization dates. In addition, when errors are identified the supporting text related to the error explains the nature of the error.

Checklist Points
Points earned or deducted based on responses inside a checklist. Checklist scoring is controlled within the checklist, not in the metric. Scoring within checklists is optional.

Claim Type
The category of claims being audited (e.g., Professional, Facility, Dental). Claim type is selected in the Audit Guideline.

Header Element
A Data Element that appears in the “header” section of the worksheet (patient-level / claim-level context such as MRN, DOB, payer).

Line Element
A Data Element tied to service-line details (e.g., DOS, CPT®/HCPCS, modifiers, units).

Display
A Data Element setting meaning it is visible for reference but not audited or scored.

Reported Data
The value the provider/coder selected or the information billed on the claim.

Review
A Data Element setting meaning it is audited/tracked. It may allow corrections and comments but does not have to impact scoring. A metric must be assigned for scoring to occur.

Metric
The business rule that tells the system what to do: score the element, apply errors, or trigger a checklist. Metrics can apply to a Data Element or the entire chart.

Metric Points
Points earned or deducted based on metric rules (e.g., incorrect CPT, missing modifier). These points are configured in the metric.

Error Option
A selectable finding tied to a metric (e.g., “Overcoded,” “Unsupported,” “Missing”). When selected, it can deduct points or be tracked with zero points.

Deduction
The point value subtracted when an Error Option is selected. A deduction can be 0.0 (tracked only) or a scored value (0.1 up to 90).

Not Scored
A scoring configuration where findings are tracked, but do not change the score (used for education, trending, or reporting without “dinging” an auditee).

Trigger
An automated rule that causes something to appear during the audit. Most commonly: a metric triggers a checklist when criteria are met (like a specific CPT code).

Supporting Text
A checklist feature that controls how auditor responses appear in comments. For certain question types, you can use [value] to insert the entered/selected response into a standardized sentence.

Reporting
Where audit results are summarized and analyzed. In general:

Metric results show in the Audit Summary
Checklist results show in Checklist Details
Combined results show in Data Element Results