NCDR National Audit Information

Participant ID:

Registry:

Your hospital was randomly selected to participate in the annual NCDR national audit for the registry selected above. At this time, the RSM or a representative at your hospital, has downloaded the NCDR audit notification. To ensure a smooth process to transfer medical records from your hospital to the auditors, we need some information

Registry Site Manager (RSM) Verification

Please complete the section below to ensure we have the correct person as the RSM. Select one of the two options below and provide your name and contact information.

Current RSM: My name was on the NCDR automatic notification email and I am the RSM for this Registry. My contact information is available below.
New RSM/Other User: The NCDR automatic notification email was sent to the designated RSM but that person is no longer affiliated with the hospital or the Registry. Please complete the following for the purpose of the audit (note- you also will need to have this corrected with NCDR business support):

RSM:

Name:

Phone:

Email:

HIM Director Contact Information

Please provide below the contact information for the HIM/Medical Records Director for your hospital.

Name:

Phone:

Email:

Data Abstraction & Submission to NCDR Registry

We need to capture the method that your hospital used to abstract and submit data during the period under this audit.

Method:

Submission of Source Documentation

To transfer the medical records to the audit vendor, please select one of the following options to submit the source documents. (Refer to Appendix D-3 to review the options).

Using the audit vendor’s sFTP (preferred method)
Using a third party vendor (e.g. CIOX, HealthPort, IOD, MRO) requiring the use of their sFTP.
Providing the auditor access to the hospital’s electronic Medical Record (EMR) system (not preferred)
Mailing encrypted CD-ROM/DVD/USB Device (not preferred)

Method:

Who will be uploading the files to setup an account for?

Other Hospital Staff Contact Information

Name:

Phone:

Email:

Third Party Vendor

The audit vendor will contact the RSM with necessary information to gain access to the sFTP

Third party vendor name:

Providing the auditor access to the hospital’s electronic Medical Record (EMR) system

EMR Name:

The audit vendor will contact the RSM to discuss feasibility and the process to provide additional information. By selecting this option, your hospital is forfeiting the possibility of an appeal if it is offered.

Mailing source document on an encrypted CD/DVD/USB device which must be mailed to the audit vendor’s address. The audit vendor will contact the RSM with the address. DO NOT send to the ACCF office

Verification of source documentation – Required

To ensure that the medical records submitted to the auditors are complete and NCDR has all the source documents in the event of an appeal, the Audit Submission Attestation Form (Appendix E) must be completed and submitted as well. Indicate below the hospital staff that will be reviewing the pdf files with the medical records prior to uploading them to the secure portal (i.e. RSM or other individual).

Staff Member:

Name:

Phone:

Email: