e/m (evaluation management) audit tool efficiencies

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E/M Audit Tool Efficiencies

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

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”

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 “we’re all getting sicker”)

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

2013: Audits are a massive federal money-maker

2013 numbers:

You can’t 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 don’t reflect audits and monies recovered by OIG, CERT, MACs, MICs, ZPICs, HEAT, PSC, DoJ, or private payer audits

2012: OIG declares war on E/Ms

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

E/M ProCheck Benefits

• You don’t 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

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


Download the OIG’s hit list of 1,700 NPI numbers

http://decisionhealth.com/pdf/OIG_FOIA_list.pdf


For questions, price quotes, custom demos, contact:

Erica Evans Product Consultant

1-301-287-2394

[email protected]

Gary Belski Product Consultant

1-301-287-2285

[email protected]

e/m (evaluation management) audit tool efficiencies

Health & Medicine