Thursday 10 October 2013

E/M Auditing For Compliance: Ensure That You Are Compliant With The Documentation Guidelines

The regulatory and compliance guidelines are making their presence felt in the ever-changing environment of coding and billing so, physicians are making efforts to minimize the risk of audits. As an example, it can be said that MACs often review E/M services and any provider using targeted E/M codes are prone to audits. It is essential to keep in mind a few guidelines for E/M auditing for compliance 2014.

In order to determine the risk for an audit, it is essential to compare the use of E/M codes by the provider to other physicians. CMS publishes utilization data of Medicare Part B every year to ease comparison.

One can also review the service volume. Apart from the service type distribution that has been billed by the physician, the volume of the services offered can also lead to audits. In order to determine if the physician faces any risk, a comparison of the total annual revenue to specialty standards can be done. This information is available through MGMA and other organizations as well that are involved in gathering data and publishing reports. There are various percentiles and any provider ranking in the higher percentile group is an easy target for audits.

One also needs to analyze physicians. Usage can be separate from revenue and there is average level of service for a specialty, services need to be coded accordingly. Differences in utilization can be due to various mixes of patients, sub-specialization, increased productivity or marketed service areas. But at the same time, improper coding can be cited as a reason to high usage along with false claims and inflated documentation.

To make coding and billing compliant, it is important to understand how accurate physician coding needs to be. At the centre of every corporate compliance plan lies a truly effective auditing program. By pairing ones auditing program to highlight the auditing measures of other prominent payers one can reduce risk and ensure compliance.

If you are looking for online medical coding updates, AudioEducator is the place where you can choose a wide range of medical coding conferences related to E/M auditing for compliance and orthopedics conferences to prepare for the year ahead.

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