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I'm doing a coding audit and I'm reviewing the accuracy of the coding for diabetes with acute conditions for risk adjustment. Coders should only be
I'm doing a coding audit and I'm reviewing the accuracy of the coding for diabetes with acute conditions for risk adjustment. Coders should only be coding acute combination codes in cases where the patient is currently experiencing the complication in an acute setting, but often it's coded regardless of setting. We'll be using judgment sampling for this audit. With a judgment sample we can review claim history on a sample of our population of 894 diabetic patients over a period of time, and identify based on the sample how likely this would be coded correctly. We can use a confidence interval to identify whether the sample represents the whole population accurately by comparing the accuracy of the coding to past reimbursements. This information can help us analyze to determine a 95% confidence level in appropriate coding for appropriate reimbursement for acute conditions, plus or minus 5%
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