PDGM Record Audits

Your records provide a wealth of information. Fazzi’s expert auditors will conduct the following reviews of your records to uncover areas needing attention for success under PDGM.

  • Coding and OASIS Audit: The PDGM case mix relies on accurate primary and secondary codes and an accurate assessment of OASIS functional Items. Fazzi will conduct a side by side audit of your ICD-10 codes and key OASIS Items to assess accuracy and uncover areas where clinician education is needed. We’ll provide insight on codes that will not be accepted under PDGM and on OASIS Items that impact patient outcomes and the functional assessment portion of the PDGM HHRG calculation.
  • Plan of Care Compliance Audit: It’s important to remember that while PDGM changes payment calculation, it does not change the Conditions of Participation or other regulations. Excellent documentation will be essential as increased scrutiny will continue under PDGM. Fazzi’s full compliance audit will provide you insight on the level of excellence with overall documentation including evidence of eligibility, case coordination for PDGM clinical groups and, adherence to supplemental orders.
  • LUPA Audit: PDGM will create additional complexity in managing LUPAs with different thresholds for each clinical grouping. Preparation begins with an analysis of your current practices. Fazzi’s LUPA audit will help you determine whether LUPAs tend to be appropriate or not and – why. Fazzi auditors will review an entire episode to provide you information on gaps and successes with LUPAs that will help you prepare for the new range of LUPA thresholds in PDGM.

The minimum sample size for each audit is 20 records.

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