Hospital Bill Audit Assistance Needed

[RNCM]

! NEED ASSISTANCE PLEASE!

HELP!!! I am trying to develop a chart auditing (Internal Hospital Bill Audit) position in the hospital where I work - Unfortunately, there are few resources that I can find regarding this role!

Can anyone enlighten me on what sort of things you see people doing in this type of role, and what should be in the job description?

Also, any books or resources that would be helpful to have?

I sure appreciate the input!

Loving Case Management!

RNCM:D

[osusana]

Hi, if you are talking about auditing charts for the correct criteria for observation verses admission and to check that they are being billed correctly, you can use the PEEP worksheet and compare what the hospital should have billed (if the correct criteria was used) and compare that to the UB92. For example, a patient was put in as an admission and should have been an observation and Medicare was billed the admission rate then a correction will need to be sent to Medicare so the correct reimbursement can be made. If this is not what you are referring to, if you could be more specific. Hope this helps.

Sue

[RNCM]

Thank you OSUSANA.

Actually, I am more interested in finding info relating to a financial chart auditor - ensuring that itemized charges on a hospital bill are adequately substantiated in the patient's medical record. (Example - if 10 doses of medication are charged for, is there documentation in the record that the patient received 10 doses of medication? etc.etc.etc.)

Thank you for any assistance you can provide!

RNCM:cool:

[RNCMAS]

I am a chart auditor I audit the itemized bill and compare it to the medical record. I belong to a group called AAMAS and have become a Certified Medical Audit Specialist with that group. The hospital group I work with has 6 hospitals and we are assigned a hospital we audit bills for errors both over and under charges. We identify trends of errors and report to the financial directors at the facility we are assigned. We work out of the Chargemaster services. We do defense audits also. We work with our chargemaster consultants to educate departments and staff that the errors are occurring in. Hope this helps you some.

[Mijourney]

You can check out the American Association of Medical Audit Specialist website at http://www.aamas.org. Or, the Association of Healthcare internal Auditors at http://www.ahia.org. I'm sure that you may find some resources that can help you from these websites.