Facilities: We’ve heard you, and we’re making changes to our audit process

We have heard you, and we are making changes to our Diagnosis Related Groups (DRGs) and Ambulatory Payment Classification (APC) audit process based on your feedback. Our new, updated Quality Audit Program recognizes high performing facilities by reducing the facility's annual DRG and APC audit requirements based on previous audit results.

What has changed?

Instead of the current monthly audits, high performing facilities that qualify for fewer DRG and APC audits will be audited every six months based on each facility's DRG and APC claim volume.

How will facilities be notified?

Facilities or ACNs will be notified by their Provider Performance Specialist if they qualify in the new audit program.

How can you reduce facility audits?

Your Provider Performance Specialist will be reaching out to you or your ACN to provide your current performance and eligibility status in the program. Or you can reach out to them directly Provider Performance Specialist.