Auditing Evaluation and Management Services: A Step-By-Step Guide to Accurate Coding, Reimbursement and Compliance, Second Edition
Joe Rivet, CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHC
Turn E/M audits into informative reports that minimize your compliance risk
The government is increasing its scrutiny of physician E/M coding. Conducting your own E/M coding audits is best practice to effectively:
- Analyze complex code assignment options to select the appropriate code
- Assign an appropriate E/M code based on documentation in the record
- Identify opportunities for increased revenue and ways to reduce compliance risks
- Understand the rules and regulations that apply to E/M services billed to Medicare
Auditing Evaluation and Management Services is an essential tool to ensure audit success and E/M compliance. This second edition goes beyond the fundamentals of E/M coding and delves into the gray, problematic compliance areas.
Author Joe Rivet delivers step-by-step guidance from beginning to end of the E/M audit process. You’ll learn how to
- Select an E/M code,
- Conduct an entire audit of your E/M services
- Report your E/M audit findings
With this foundation, you’ll be well prepared to enhance compliance and identify undercoding, underreporting, overcoding, revenue opportunities, and avenues for documentation improvement.
Auditing Evaluation and Management Services, Second Edition, will help practices enhance existing auditing programs by explaining how to determine accurate E/M error rates and assess risk.
You will learn how to:
- Determine proper E/M code selection
- Conduct risk assessments
- Structure audits, using the provided E/M audit tool, and package audits
- Create provider audit summary reports, practice audit summary reports, missed revenue reports, and an action plan
- Follow guidelines for facility E/M services and interpret the rules governing E/M services involving residents or fellows (including acceptable and unacceptable documentation)
- Develop a compliance plan and educate a variety of audiences from physicians to coding staff
Take a look at the table of contents
- E/M Code Categories NEW!
- Selecting an E/M Code
- Conducting a Risk Assessment
- E/M Audit Structure
- Using an Audit Tool
- Packaging an Audit
- Facility E/M Services NEW!
- Teaching Physician Services NEW!
- Developing a Compliance Plan
- Education Techniques NEW!
- New chapters devoted to:
- E/M Code Categories
- Facility E/M Services
- Teaching Physicians
- Education Techniques
Who will benefit from this book?
- Auditors and compliance officers in physician practices and hospitals
- Health systems that own physician practices
- Business managers
- Office managers
- Practice administrators
- Coding, billing, and reimbursement managers and staff
Earn continuing education credits
American Academy of Professional Coders
This program has prior approval of the American Academy of Professional Coders (AAPC) for 3 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content, or the program sponsor.
American Health Information Management Association
This program has been approved for 4 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
Here are the tools you’ll find in the Auditing Evaluation and Management Services, Second Edition:
- Audit adjustment worksheet
- Audit summary report
- Audit tracking form
- E/M data report
- Missed revenue report
- Planning checklist
- Provider audit summary report
- Provider results spreadsheet
- Provider scoring matrix based on percentages
- Provider scoring matrix based on point system
- Risk assessment spreadsheet
- Sample policy on standardizing E/M audits
- Training process for a new auditor
- E/M facility coding guidelines recommended by AHA & AHIMA
- 1995 & 1997 E/M documentation guidelines
- E/M audit tool
- HPI/ROS tool
- Outpatient visit template
- Single-organ exam template
- Useful websites
Meet the Author
Joe Rivet, CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHC, is the corporate compliance officer at Wayne State University Physician Group, a large physician group affiliated with Wayne State University School of Medicine in Detroit. He has direct responsibility for all compliance activities, including coordinating, communicating, planning, implementing, and monitoring the compliance program.
Order your copy today!
Published: June 2011