This audit program is designed to be conducted as either a desk or an on-site audit.  The targets of these audits can be determined by either the identification of a specific facility, DRG code or pursuant to National Audit data-mining results.  These data-mining efforts are performed through the application of proprietary programming designed to specifically focus on a multi-tiered selection process which identifies outlier DRG claims based on medical and financial measures combined.  Our selection criteria are periodically updated to address new targets and trends. 

The audit process consists of a thorough review and recoding of the medical record in order to validate the procedures and diagnoses coded that resulted in the DRG billed by the provider and reimbursed by the payer. Subsequently, through the use of nationally accepted technology, National Audit recodes and re-prices the claim based upon the audit results, thereby providing clients with accurate payment validation information for each claim.

Through the continuous tracking and trending of its state of the art database, National Audit is able to optimize its audit process and results by focusing on historically abusive facilities or incorrectly coded/abused DRG codes.