AuditGuru™ - Feature Specification List

Medical record and claim audits are becoming a way of life in the healthcare industry. The Wellington Group’s AuditGuru™ is a comprehensive auditing environment that streamlines the audit process for healthcare organizations.

Your auditors often spend a great deal of time at the beginning of an audit developing the sample of claims to audit and gathering the associated claim information. They also spend significant time at the conclusion of the audit developing a report summarizing the results. By automating these portions of the audit process, AuditGuru™ allows your auditors to focus more time on auditing and less time on sample creation, data collection and report preparation. AuditGuru™ also includes AuditAssist, our advanced revenue cycle, compliance and RAC preventative editing system. As a result, AuditGuru™ enhances the productivity and accuracy of your auditors.

The foundation of AuditGuru™ is its claim repository. Wellington initially loads your claim history (837s) into the claim repository. On an on-going basis, current claims are automatically uploaded to the repository by an automated daily or weekly secure file transfer process.

Creating an audit is easy. AuditGuru™ leads you through each step of the process – naming the audit; defining the sample population and time period; selecting the sample size, sampling methodology, type of audit, and pricing methodology; and choosing the types of edits for AuditAssist to include. Based on your selections, AuditGuru™ automatically generates the sample of claims to audit.

Now you’re ready to start auditing claims! The auditors enter their results (e.g., diagnoses, procedures, etc.) into the audit forms. AuditGuru™ automatically compares the initial claim with the audited claim and identifies any errors as well as calculating any change in payment.

Once the claims are audited, AuditGuru™ automatically generates a PowerPoint presentation summarizing the results and financial impact, based on the type of audit performed (e.g., coder performance, clinical documentation). Similar audits from different time periods can even be combined to track trends and monitor performance.

AuditGuru™ can be used by a wide variety of providers, including hospitals, clinics, physician practices, ambulatory surgery centers, long term care and mental health facilities. AuditGuru™ also supports multiple types of audits:

• Coding (Inpatient, Outpatient and Physician)
• Coding Staff Evaluations
• Clinical Documentation
• Defense Audits
• Linked Claim Audits (Institutional and Physician)

AuditGuru™ even provides a training environment for the upcoming ICD-CM-10 conversion, allowing you to use your own claims as the basis for training. Your coders can then become proficient at coding for your services.