Reminder: Here’s what you need to know about catastrophic case audits

Here’s what hospitals need to know to prepare for a catastrophic case audit.

• Blue Cross Blue Shield of Michigan sends appointment letters at least 30 days in advance, informing hospitals about the cases to be audited and the list of items needed to conduct the audit.

• Catastrophic case outlier audits need to include the complete medical record, progress notes and medication administration sheets. They should be in the order of the most recent date. Also include emergency room records, outpatient procedures, the utilization review worksheets and a copy of the most current itemized bill.

• Only late charges submitted to Blue Cross at least 30 days before the audit will be considered part of the review. Blue Cross must complete the late charge claim adjustments and post the new claim information to our financial systems before the audit.

• If the audit is held on-site and you have electronic medical records, provide a computer and log-on information for each auditor. Make someone available to help the auditor access and navigate your electronic medical records.

• Each auditor will need an electrical outlet for a Blue Cross computer and a telephone in the designated audit room.

• If the audit is conducted at our offices and you give us Web access, we’ll need log-on information for each auditor and a contact person to help access the electronic records.

• The Blue Cross auditor usually makes a courtesy call to the hospital’s contact person before beginning the audit to answer questions that may occur during the audit preparation.

• Blue Cross will give you daily deletion sheets during the audit so you can provide additional supporting documentation. While on-site, our auditor will identify the itemized bills that need to be mailed to Blue Cross.

• Provide the name and title of the person who will receive the reporting letter and include his or her email address. The hospital staff is responsible for sharing audit findings with other individuals and hospital departments.

After you receive the reporting letter, the appeal process gives you an opportunity to provide clarification or include missing documentation. Hospitals are allowed 50 calendar days from receipt of the audit reporting letter to submit a written request for an internal review.