Hi Erin,
For our providers, 90 - 100% is passing with no further action and is considered low risk, 80 - 89.9% is also a passing score but requires feedback which could be completing a refresher module or some other corrective action and this range is considered a medium risk, and 79.9% and below is an unsatisfactory score that requires a provider and/or coder meeting and a subsequent review and this range is high risk.
New providers are audited within 6 months of their start date. We perform risk-based E/M reviews that are selected based on data analytics. We also have work plan reviews that are planned for the fiscal year.
Hope this helps, happy to provide more context if needed.
Thanks,
Tammy
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Tammy Morris
Compliance Director
Johns Hopkins University School of Medicine
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Original Message:
Sent: 04-17-2025 02:02:50 PM
From: Eliza Bardin
Subject: Auditing policies
Our minimum accuracy standard is 90%. Our providers generally code their own encounters. If a provider obtains 90% or higher, they are reaudited in 12 months. If they obtain 70-89%, they are reaudited in seven months. If they obtain less than 70%, they are reaudited in four months.
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Eliza Bardin
Associate Director, Healthcare Compliance
University of Central Florida College of Medicine
Original Message:
Sent: 03-25-2025 05:25:54 PM
From: Erin Maynard
Subject: Auditing policies
Hello!
Can you please share your policies or best practices concerning coder and provider minimum accuracy standards and how often coders and providers are audited/reaudited (both new and existing)?
Thank you!
Erin
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Erin Maynard
Provider Education Manager
Oregon Health & Science University School of Medicine
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