Adjust Score Thresholds
The first step to creating a robust workflow for reviewing charts and addressing errors is setting up a threshold for “Failed” and “Needs Review” audits. The standard approach for audit thresholds is below 90% failure and below 100% needs review thresholds. You can follow the steps below to set up your audit thresholds:
Go to the question studio tab, select the relevant question set, and click ‘Edit Question Set’
Set the threshold for “Failed” audits to be 90% as shown here
To set another threshold for “Needs review” audits, first you’ll need to create a new flag by clicking ‘Manage Audit Flags’ and creating a new flag called ‘Needs review’
Now, you can set a new threshold following the same step as 2 above for “Needs review” audits at below 100%
That's it! Your audit score thresholds are now all set! Next up is determining question scores. For now, you’ll just want to identify any critical questions. Critical questions are for your most strict requirements. The questions were when they fail, the provider should be notified immediately, and the error should be corrected. These are some examples of critical questions relating to 97153 requirements:
Was the session not double billed with any other sessions?
Was the note signed within 24 hours of the end of the session?
Is the session narrative NOT copied/pasted from a previous session?
Were all relevant fields of the session note filled out?
Once you have identified which questions are critical, take these steps to apply critical severity in Brellium:
Still in the question studio, click the edit icon to the right of a question to edit the severity
Click on the severity box in the bottom right-hand corner, select Critical, and update the question
Thats it! Now you have your audit threshold and your question severities all set up!
Audit Flags
Audit flags are an extremely helpful way to organize your charts based on fixes that need to be made. Once we set up flags, we can use them to organize audit results so that our team can access exactly what they are looking for in a flash, or to set up automated emails to share targeted feedback to providers.
After adjusting our audit score threshold and applying critical severity to certain questions, we’ve already set up three flags!
Failed: Gets applied automatically to any audit that scores below the ‘Failed’ threshold (90%)
Critical: Gets applied automatically to any audit where a ‘Critical’ question is answered incorrectly
Needs review: Gets applied automatically to any audit that scores below the ‘Needs review’ threshold (100%)
These flags are all we need for now, but if you need to make future changes, you can always go to ‘Manage Audit Flags’ in the ‘Question Studio’ to adjust them! To see more on creative ways to use flags, see our best practices document below.
Set up Automated Emails
Now that we have our flags set up, we recommend creating three separate email templates for each.
Critical errors: Here, we recommend creating an instant email template so that the person reviewing in Brellium can immediately catch critical errors and send them to the provider to be addressed. See this guide to create an instant email template:
Failed: We recommend creating a weekly email schedule for failed audits so that swift adjustments can be made by the provider. To create a weekly email schedule see the guide below.
Needs review: We recommend setting a monthly schedule for audits with the ‘Needs review’ flag applied to them, since these notes are less likely to be flagged by insurers. See the same guide below to create this.
Congratulations! You’ve now set up a starting workflow and you are ready to leverage Brellium’s AI to supercharge your QA process!
Next, if you want to explore other ways to get the most out of the platform, you can check out our best practices document here: