Practice Intel:

Target Compliance Scores

Target Audit Score

The target audit score for our providers and clinics is between 80-85.

Achieving a score of 80-85 minimizes risk of failing an audit while also decreasing the likelihood of over documentation within your notes.

Understanding Audit Scores

PredictionHealth leverages your data and our AI to show you a number of metrics regarding the health of your documentation compliance. The following steps outline a workflow for seeing high-level information about your clinic’s audit score performance and then drilling down understanding the nuances of each individual provider’s scores.

Documentation Compliance: Audit Score

This section of the platform gives you a high level overview of your clinic’s average audit scores. At the top of this page you will find a box that shows your organization’s audit score over the selected date range in your filters.

Underneath this is the “Audit Score Over Time” graph. This graph shows a trendline for the clinic’s audit scores and defaults to showing the last six months. Please note, this graph’s date range will update based on the “From” and “To” date range filters you’ve selected.

The line graphs in this section are color-coded by risk level:

Continuing to scroll down on this page will then show a graphical breakdown of your highest and lowest performing providers. You will then see a further breakdown of audit score both by clinic and by provider including breakdowns of the note type (Initial Eval, Follow Up, and Progress visit) for each.

Documentation Compliance: Detailed Provider Scores

After seeing the high level overview of your clinics/providers the next step is to dig into the “Detailed Provider Scores” tab. This will outline the score for each component within each note type for every provider in your organization. This table follows the same color-coding key as the previous section of the platform and each column is sortable by clicking on the table headers.

Above the table you will find several toggles.

• Copy Forward: this allows you to see the percent of words copy-forward on average by your providers as well as the percent of charts with all CPT codes copied forward

• Under-Documentation: this allows you to see the percentage of some individual subcomponents that are under-documented.

Interpreting the Detailed Provider Score Section

The primary functionality of this section is to be able to compare trends amongst providers or within your organization with respect to individual components of each note type. The color-coding will allow you to quickly identify outliers within your organization.

Things to Remember

• The target total average audit score for each provider is 80-85!

  • Once a provider achieves the target score range under the “Avg Audit Score” column it is advisable to consider the compliance goal as met even though the granular score view may still highlight some areas for improvement in the note subcomponents by the indicator of yellow or red colored cells.

• Not every subcomponent carries the same weight!

  • Certain components carry more or less weight in our scoring system. The Detailed Provider Score Tab is designed to give you an overview of each component but does not detail information as to the overall importance of each component. Because of this, a provider may still have a “passing grade” in his/her overall average audit score but still score poorly on several individual components. The advice from the previous bullet point continues to apply here because of this. A more detailed understanding of the impact of component weightings on an individual provider’s score can be found under the “Focused Snapshot” section of the platform.

Documentation Compliance: Over/Under-Documentation

This section of the platform outlines the percentage of notes that are graded as being over or under-documented at a clinic level and at a provider level. Any data that falls to the left of the zero line denotes under-documentation, any data that falls to the right of the zero line indicates over-documentation. Because of this, a “perfect” score on all sections of this graph would show no bars (all bars at zero). We have not identified a target score for this section. Insead, these graphs are designed to help you quickly identify outliers within your organization for both providers who are under and over-documenting.

It is helpful to leverage your filters in this section of the platform. Here, you can use the Visit Type (General) or (Specific) filters to help you determine whether a therapist might need to reduce documentation quantity for a certain note type.

Documentation Compliance: Copy Forward

This section of the platform looks at the percentage of words that are copied forward from one note to the next and gives you a breakdown of these numbers both at a clinic and a provider level. 

Interpreting Copy Forward

As with the previous section, these graphs are designed to help you quickly identify outliers within your organization.

Average % Copied Forward by Provider/Clinic

The following graph outlines the percentage of words that are copied forward from one note to the next by each provider. This section analyzes all of the text of each note that is not a header section.

Things to Remember

• A perfect score on this graph is not zero! We encourage our providers to leverage their EMR tools which include making use of some text that is pulled from one note to the next as well as templates. 

• Different EMRs pull through different amounts of information from visit to visit, which is why we don’t have a universal recommendation for Copy Forward.  Additionally, providers and clinics have unique workflows so it becomes impossible to set a single target score for all of our users. Instead, we recommend using this information to first target your outliers and drive them closer to the average in your company.

% of Information Copied Forward by Provider/Clinic

The following graphs outline the percentage of time certain percentage ranges of each note is copied forward at both a clinic and provider level. Hovering over the bar graph will bring up this percentage breakdown.

Things to Remember

• As with the previous Copy Forward section, there is no official target score here. However, we do have several recommendations:

  • Utilize these graphs to identify trends in your copy forward habits at a clinic and provider level

  • The 90-100% range is important to keep an eye on! In this example we can read this graph as stating: “24.1% of the time 90-100% of all of the text in all of the clinic’s notes within this time frame were copied forward”. From an audit risk perspective, when 90-100% of the note is copied forward it becomes difficult for an auditor to determine whether each individual note has actually been updated for the visit in question (notes in this range of copy forward are at high risk of being flagged as “clones” or exact copies from visit to visit).

    • The general advice for this metric is to have a score of low single digits at most in the 90-100% range. A score of 0% in this range is preferable.

Focused Snapshot

The focused snapshot is designed to be a page where you can find all actionable data specific to a clinic or to a provider of your choosing. In this section you will find detailed audit score information as well as a practice metrics recap section specific to the clinic/provider chosen in the filters.

Areas for Improvement

This table details the top target areas for improvement with respect to the clinic/provider’s audit scores.

This table shows the most impactful component to target for improving audit scores in rank order from most important to least. The “Overall Impact” bar denotes the component’s importance in our scoring system and will help you focus on the top actionable items when addressing a poor audit score. In this table the score of each component is given alongside a generic compliant statement example. For your convenience, the “Score Reference Guide” which outlines the necessary components of a note is linked above the table.

Things to Remember

• This table will continue to call out the areas of the note that could most use improvement regardless of the score of the subcomponents or the overall score of the provider/clinic. Once the target audit score (80-85) has been achieved we recommend addressing other areas of opportunity within the platform, such as CPT Code selection with CPT Insights, Coding Efficiency or Time to Sign Off.

• This table is ranked by overall impact, therefore an item under “Area” may be listed further down the list despite having a lower overall score. In the screenshot above, you can see that the item “Progress Visit: Updated Analysis on How Patient Performed” is ranked 3rd despite having the second lowest score on the list. This is because the two preceding items carry significantly more weight in the audit score and are recommended to be addressed first.