Medical Audit

Medical Audit is defined as the evaluation of medical care in retrospect thorough analysis of medical records. It involves assessing current performance against set standards and hence, in contrast to research, does not generate new knowledge. An audit is a cyclical process which consists of defining standards, collecting data, identifying areas for improvement, making necessary changes and back round to defining new standards.

Audit means official examination and verification of accounts or financial transactions. Medical Audit is examination and verification of dealings of medical care. Mac Eachern states that "Financial Deficiencies can eventually be met with but Medical deficiencies may cost lives and loss of health which can never be retrieved".

Medical Audit  provides detailed and comprehensive compliance review programs for Hospitals, both Inpatient and Outpatient facilities, and for Physician Practices. These programs are tailored to the needs of each individual facility and focus on review, education, and support.

• Inpatient (DRG Compliance Review)

• Outpatient (APC Compliance Review)

• Peer Review Studies

• Utilization Review and Risk Management Projects & Case Studies

• PRO and Payor Denial Reviews

• Expert Witness Representation

• Education - recommendations, tools, direct discussions, classes, meetings and workshops

• Newsletters - timely educational articles

What records for medical audit and outcome analysis will the MQSA inspector want to review during the annual inspection?
 

The inspector will ask a facility to document answers to the following questions:

• Are ALL positive mammograms entered in the system?

• Are biopsy results present or was there a documented attempt to obtain them?

• Is there a designated audit interpreting physician?

• Is the analysis done annually?

• Is the analysis done separately for each individual?

• Is the analysis done for the facility as a whole?