| Physician
Practice E&M Audits
Physician
practice audits assess the accuracy of E&M coding. To put your
attention where it's needed most, audit findings focus on significant
discrepancies which impact on the E&M level and RBRVS payment.
All coding changes suggested are backed up by citations from the
medical record and reliable, definitive sources for coding guidelines.
Audits can be scheduled on a regular, recurring basis or as a one-time
review.
The
E&M Audit Process
Sample
Selection : Sample selection varies depending on
your preference. You may select all cases or leave the selection
to Clarity Coding. A combination approach may also be used. Although
troublesome cases may be one focus in the selection, a random element
should always be a feature of the case selection.
Case
Review : For each case selected, we assign the E&M
code supported by the documentation in accordance with CMS's 1995
Documentation Guidelines or 1997 Documentation Guidelines for Evaluation
and Management Services. For each case, the reviewers document their
code assignment by completing the E/M Documentation Auditors worksheet
commonly used by Medicare carriers. The reviewers then compare their
assigned E&M code to the code assigned by the practice. This
idenitfies areas of discrepancy in either documentation or case
review which lead to differing codes.
Results
are two-part. The first is a list of all cases reviewed displaying
the code assigned by the practice, the code assigned by Clarity
Coding, and a statement detailing the nature of any discrepancy.
The second is a summary of the discrepancies with recommendations
for improvements in documentation and coding practice.
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