| name | chart-audit-protocol |
| title | Chart Audit Protocol |
| description | Drafts healthcare chart audit protocols covering clinical documentation review, coding accuracy, and billing compliance. Aligns with Medicare CoPs, OIG Compliance Program Guidance, RAC preparedness, federal sentencing guidelines, and the 60-day overpayment rule. Use when drafting routine periodic audits, targeted risk reviews, proactive compliance measures, or post-regulatory-update assessments. |
| author | CaseMark |
| author_url | https://github.com/CaseMark/skills/tree/main/skills/legal/chart-audit-protocol |
| license | Apache-2.0 |
| version | 0.1.0 |
| execution_mode | open |
| jurisdiction | us |
| practice | healthcare |
| language | en |
Chart Audit Protocol
Drafts a defensible chart audit protocol that serves as both an operational roadmap and a regulatory compliance document for healthcare organizations.
Quick Start
Gather before drafting:
- Audit trigger — routine periodic, targeted risk, RAC preparedness, or post-regulatory-update
- Regulatory driver — Medicare CoPs, OIG guidance, payer contract, state licensing, or internal compliance
- Scope — timeframe, departments/providers, service types, patient populations
- Sampling approach — random, stratified, or targeted; universe size and confidence level
- Prior findings — benchmarks, historical error rates, known risk areas
Core Workflow
1. Purpose Statement
| Element | Content |
|---|
| Regulatory framework | Cite driver: Medicare CoPs, OIG CPG, RAC, payer contract, state requirement |
| Audit classification | Routine / targeted risk / proactive post-regulatory |
| Integration rationale | How audit fulfills duty to monitor under federal sentencing guidelines and OIG guidance |
| Governance alignment | Compliance committee / board oversight connection |
2. Scope Definition
| Parameter | Specification |
|---|
| Review period | Exact date range |
| Departments / providers | Named units or provider groups |
| Service types | CPT ranges, revenue codes, or care settings |
| Patient population | Payer mix, age bands, diagnosis categories |
| Exclusions | Document with rationale |
Sampling methodology — select one:
- Simple random
- Stratified (risk-factor tiers: high / medium / low)
- Targeted (data analytics, prior findings, denial patterns)
Document: universe size, sample size, confidence level (90–95%), margin of error, extrapolation basis.
3. Documentation Review
Per-record checklist:
