E/M (Evaluation Management) Audit Tool Efficiencies

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Post on 22-Nov-2014



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Protect your revenue and doctors with a proven workflow tool for chart auditing If you think the IRS is the only government agency thats engaged in aggressive auditing, think again. No fewer than FIVE separate federal entities have your E/M services in their sights, and CMS has said that audits of all types will increase in depth and breadth after ICD-10 hits in 2014. To avoid giving money back, or worse, you need workflow tools that can perform quick, accurate and consistent internal audits so you know if your services are at risk. View this recorded webinar to learn how E/M ProCheck, a top-selling chart auditing tool, can give you critical early warning of audit risk immediately, while also improving provider coding in the long term. Discover how E/M ProCheck lets you check your providers coding against local peers of the same specialty for any unusual patterns the same technique used by OIG and RAC auditors. Youll also see how quickly E/M ProCheck can perform chart audits with its simple, web-based click-and-point interface. To request more information about E/M ProCheck or to receive a custom demonstration, call 1-855-225-5341 today! Mention code EMPA1304.


<ul><li> 1. 1 E/M Audit Tool Efficiencies </li> <li> 2. Grant served as editor for the industry-leading physician practice reimbursement and management newsletter, Part B News, for five years, covering Medicare payment policy, fee schedules, compliance rules, and coding and billing best practices. Your presenter Grant Huang Product manager </li> <li> 3. E/M services are easy targets Easy to audit High-volume services as they are the single largest service type billed by providers, regardless of specialty Generate a lot of money for the carriers and other groups that perform audits Easy to claim overpayments on because of the high level of subjectivity An attractive target in an environment where healthcare spending is too high and CMS, HHS and the OIG face significant political pressure to reduce fraud, waste and abuse </li> <li> 4. E/M levels are creeping up Possible causes: Automated templates suggesting higher selection as EHR adoption skyrockets Providers feel more confident in choosing higher levels/feel the pinch from declining payments overall Growth in volume of complex patient cases with multiple ongoing chronic conditions (aka were all getting sicker) </li> <li> 5. 2013: Audits are a massive federal money-maker For every $1 the government spends on audits, nearly $8 are recouped from providers Given federal deficits and rising healthcare costs, a major expansion in the scale, frequency and intensity of provider audits is expected Providers need 1.) a way to estimate their E/M risk, 2.) a consistent way to audit their charts, and 3.) a consistent record of reports that can be produced to show good-faith compliance efforts and due diligence when the inevitable audit hits </li> <li> 6. 2013: Audits are a massive federal money-maker </li> <li> 7. 2013 numbers: You cant make this stuff up More successful audits in one quarter of 2013 than nearly all of 2011 Audits have become far more focused on overpayments RACs are just one of a half-dozen government auditing programs These numbers dont reflect audits and monies recovered by OIG, CERT, MACs, MICs, ZPICs, HEAT, PSC, DoJ, or private payer audits </li> <li> 8. 2012: OIG declares war on E/Ms </li> <li> 9. 2012: OIG declares war on E/Ms </li> <li> 10. 2012: OIG declares war on E/Ms </li> <li> 11. 2012: OIG declares war on E/Ms </li> <li> 12. 2012: OIG declares war on E/Ms </li> <li> 13. 2012: OIG declares war on E/Ms </li> <li> 14. Why use an auditing tool? Productivity analysis tells you which providers are at risk of being audited Shows you what types of E/M codes to audit, so your chart audits are not random but targeted Saves you money by identifying undercoding as well as overcoding Saves you time by focusing your audits Cut audit risk by finding and correcting issues before carriers send overpayment demands </li> <li> 15. E/M ProCheck Benefits You dont have to memorize guidelines There are built-in tips and guidelines making the audit more authoritative The ability to calculate counseling and coordination of care is built in The impact on revenue is immediately recognized A professional report is generated at the conclusion of each patient audit It is a useful, easy-to-read training tool for your providers </li> <li> 16. www.decisionhealth.com What you can expect next A brief survey will pop up immediately after presentation MUST TAKE TO GET CEUs! Please provide your feedback and indicate your level of interest in the survey CEU certificates to be sent via email post-conference You will receive a follow-up call from our product consultants, Erica and Gary Custom demos available for your organization before purchase; training is available for all subscribers after purchase </li> <li> 17. www.decisionhealth.com Download the OIGs hit list of 1,700 NPI numbers http://decisionhealth.com/pdf/OIG_FOIA_list.pdf </li> <li> 18. www.decisionhealth.com For questions, price quotes, custom demos, contact: Erica Evans Product Consultant 1-301-287-2394 eevans@decisionhealth.com Gary Belski Product Consultant 1-301-287-2285 gbelski@decisionhealth.com </li> </ul>


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