Friday, December 10, 2010

How To Have Perfect Chart Audits

When Corporate sends the list of 10 “random” case files for their audits, here is what to do:

Step 1 -  Pull the charts.

Remember, Corporate already knows exactly which charts to pull as they get a report every day on who was treated, what was done, why treatments were done, or why patients did not wait to be “converted” from Hygiene to Operative, etc.

Every day, they know how many appointments were scheduled and how many canceled.  They know what patients they saw, how many crowns were placed on each patient and who treated the patient.   I am sure they know where the treatment took place (i.e. the OR or clinic).  They know if treatment was not completed and they know why.

Each day, Corporate knows how many patients are on the appointment schedule a month or more in advance.  It is all in the computer.  It is even broken down by the department; the exact number scheduled for Hygiene\Operative\ and the Total, no doubt.  After all, this is a For-Big Profit organization.  Clinics and the employees within are answering to a “higher power” and it is not a divine being.

  • Actual revenues for the week
  • Who was off from work that week or day and why
  • Number of customers that week, in this case patients.
  • How many were new, how many were reschedules, how may kept their assigned appointment, how many did not.
  • Amount of supplies used and the difference from what was budgeted.
  • How many morning “huddles” for the week, who was there and who was not.
  • The number of returns, in this case redos.
  • Likely to include customer comment cards, the good ones, as the bad ones get tossed.
  • Any new hires, any fires.
  • Problems that need to be address, such as Nitrous Oxide levels too high in the clinic.  Those sort of things.

Step 2 - Immediately print out the account information on each chart pulled.

Step 3 - Make photo copies of everything in the chart, include a copy of the x-rays.

Step 4 - Give to the HBIC (Head Bitch In Charge).

Step 5 -  HBIC will review each file to make sure everything documented in the chart matches what the computer said was done to that patient

HBIC makes sure if the computer statement said tooth A (upper right baby tooth) but the chart said it was tooth M (lower left) that entry was corrected.

But which was true?  Without recalling the child for a look-see, who actually knows.

If they do not match, make them match.  Either by rewriting the treatment plan or correcting the record in the computer.

Maybe they will make a note to check the actual child when he or she comes back for the next visit and it will be corrected again, then maybe it will not even be checked and life goes on.

How can the chart be changed, you ask?

It is only my opinion, I would say, adjust the chart would be much easier since the account has already been billed out and you would have to add to the billing or make other  billing corrections.  So chart changing might be the best choice.

With such a high turnover at these places, it seems it would be difficult to correct chart notations to match the original hygienist, dental assistant’s and dentist’s notations. 

Maybe the best would be a whole new document.

Except when one forgets, that the new handwriting belongs to a new employee who was not there when this patient was seen, but who is going to look at that, right?

If the original employee is still there, the HBIC could just approach the hygienist, assistant or associate dentist and threaten them with their job, if they do not fill it out or at least sign the new and improved treatment plan and charting.  Talk about being put on the spot, it is not like the employee would have a couple of days to think about it.  After they sign it, what do they do then?  You do as you are told if you want to keep your job, feed and clothe your family and keep a roof over your children’s head.

Maybe you also forgot to have the parent sign the treatment consent form.  What about the “It’s Ok To Strap My Child Down, Man Handle Them, and Send Them Back To Me Covered in Puke and Urine” form.  Ooops. 

That would be easy to correct, especially if they have the parent’s signature on other forms.  Just trace it, right?  not send it.

Again, who is going to check?

Of course, there are times when things are crazy in the clinic and treatments completed will get left off the chart.   But how did the treatment get on the computer account if it was not charted?  Hmmm…

The dentist is supposed to review the chart of the patients they saw at the end of the day.  Ideally, the dentist should be doing a quick review of the chart immediately, as the patient is being cleaned up and walked out. 

I think it would be good, to do as my doctor does and as soon as he steps out of the room with my chart in hand, out comes his recorder and he immediately records in his very own voice what treatment was done, what diagnosis was made and when he wants me back.

Mistakes happen and agreed, many of the assistants are not trained and most likely worked at the local 7/11 last week.

Step 6 - The copies of the charts are put into a Fed-Ex package and shipped off for analysis.  In about a week or so, a grade is handed out, just like in school, and points given toward your bonus for doing such a marvelous job.

I bet if you can ask, the office staff will know how well they do on chart audits, and whether they are at the head of the class or sucking hind tit.

Of course this is no way to do a chart audit.  The Regional Manager should be doing this, if he had a clue what he was doing and not a former mortician or something.

Better, would be the company Compliance Officer  off his or her ass or Assistant Compliance Officer, if there was one, to fly around from clinic to clinic and do the audits.  What about an outside objective party do the chart audits?

Surprise visits are the ticket to proper chart audits.  An auditor marches in, briefcase in hand, and start pulling charts.

When chart audits are done in this manner it means nothing when told how fantastic Compliance is within the company, in fact, it is laughable.

I have heard FORBA has an in-house specialist on this matter.  They may even give “webinars” on the best possible signature forging technique.  Who knows.  I guess you could just leave that document out and