A computer with a check mark in the corner

From manual to automatic: The road to a streamlined review and audit process

  • The challenge

    University of Utah Health started the audit process in a spreadsheet-based world. The spreadsheet changed and adapted over multiple years, and grew when new information was added. Although the organization made it work, it was far from the most efficient or unified approach to manage audits. In addition to a manual process, each auditor had a slight variation in their approach.

    The ultimate outcome? A time consuming and inefficient way to understand and manage the data. As the team’s responsibilities continued to increase, they needed a better process and more supportive technology to make their audits more efficient.

  • The solution

    University of Utah Health is a long time partner of 3M Health Information Systems. The organization partnered with 3M to deploy two new prospective prebill and retrospective audit solutions: 3M™ 360 Encompass™ Audit Expert System — Inpatient Prebill Review and 3M™ 360 Encompass™ Audit Expert System — Code Audit. The goal was to use technology to streamline, automate and standardize the review and audit processes, integrating a more efficient practice across the different functions. University of Utah Health pioneered these two solutions and provided valuable feedback and user experience data that the 3M product team used to enhance the solution.

A video still of Nancy Treacy, Data Integrity Manager,
  • Prospective prebill review process

    The new edit, review and audit solutions within the 3M Inpatient Prebill Review module enable actionable custom edits to identify errors at the point of coding, as part of the coder’s workflow. These custom edits were developed to specifically address the coding errors identified by the University of Utah Health coding and auditing management team. Coding errors are resolved within the coding workflow rather than placed on an additional hold, or worked on further downstream in the revenue cycle, which facilitates better coding accuracy.

    In addition to the actionable custom edits, 3M Inpatient Prebill Review prompts specific criteria to a second level review for additional analysis. According to Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS, manager of data integrity at University of Utah Health, “ultimately the additional review could eliminate rebills and enable coders and auditors to work together and provide quicker and more timely feedback.”

    The second level review process allows the auditors to take a deeper look at their mortality review gains and losses, identifying net dollar changes that could affect the facility’s revenue stream.

  • Retrospective audit process

    In addition to using actionable custom edits and second level reviews as part of the prospective coding accuracy process, University of Utah Health also integrated 3M Code Audit for retrospective reviews. Retrospective audits are completed within the 3M™ 360 Encompass™ System, referencing the codes and the documentation used to create the patient record and removing the manual methods required to create randomized audits previously managed via email.

    3M Code Audit provides a more efficient way to initiate retrospective audits, review the code set, provide two way communication and agreement between the coder and the auditor, and operationalize the overall process. The retrospective audit process also provides insight into coding errors and challenges. This helps direct targeted education and potential new custom edits and review opportunities that can be added to the prebill process– all within a single platform.

The University of Utah Health’s results with 3M

University of Utah Health took full advantage of not only changing a manual process for retrospective reviews, but also creating a standardized and more effective way to address potential issues at the front end of the coding session with a prebill process.

Ultimately, the integration of both 3M Inpatient Prebill Review and 3M Code Audit streamlined the coding accuracy and audit process, which is critical to University of Utah Health’s commitment to quality.

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    Reduced rebill time from 30+ days to 3 days post-patient discharge with the prebill process

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    DRG mortality review identified $210k potential undercoding

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    Issues resolved at the front end of the coding process

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    Audit output doubled from 5% to 10% per coder per month

"Ultimately the additional review could eliminate rebills and enable coders and auditors to work together and provide quicker and more timely feedback.”
Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS, manager of data integrity, University of Utah Health

As with any case study, results, outcomes and/or financial improvements should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on a facility’s circumstances.

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