Auditing Evaluation and Management Coding

Everything you need to easily conduct an E/M audit—and ensure you receive the reimbursement you deserve!

Your physicians bill evaluation and management (E/M) codes every day. E/M coding is an essential part of your practice’s revenue cycle and it’s also on the Office of Inspector General’s (OIG) hit list. This means that it’s more important now than ever to accurately report these codes. Conducting an E/M audit will help your practice enhance its revenue and stay under the OIG’s radar. Turn to Auditing Evaluation and Management Coding: A Step-By-Step Guide to Enhancing Your Practice’s Revenue and Compliance for the expert advice and guidance you need to perform an E/M audit at your practice.

Conducting an E/M audit will help you:

• enhance compliance and recognize areas of risk at your practice
• identify patterns of undercoding and upcoding
• spot revenue opportunities
• improve documentation

A complete audit program

Written by Joe Rivet, CPC, CCS-P, CICA, CEMC, and Sharon Bolarakis, CPC, this easy-to-follow book and CD-ROM guides you through the entire E/M audit process from start to finish. With it, you’ll have all the tools, templates, policies, and procedures you’ll need to establish a quality E/M audit program at your practice. You’ll learn how to:

• differentiate between the 1995 and 1997 guidelines
• use an audit tool to review your records
• organize your E/M audit
• perform a risk assessment
• develop an audit report
• devise a compliance plan
• schedule follow-up audits
• and much more!

With Auditing Evaluation and Management Coding, you’ll also receive advice and guidance about how to select an E/M code, conduct an entire audit of your E/M services, and report your E/M audit findings.

Readers will benefit from case studies, a supplemental chapter on how to level each E/M service, and a CD-ROM with customizable tools and forms. We’ve even included quiz questions at the end of each chapter so you can test your knowledge, as well as several case studies you can audit on your own using the audit tool we provide.

Take a look at what's inside:

• Chapter 1: Choosing an E/M code
  Offers a step-by-step approach to choosing an E/M code, including determining the history, exam, medical decision-making, counseling, coordination of care, nature of presenting illness, and time portions of the service.
• Chapter 2: Performing a risk assessment
  Outlines areas that tend to be high-risk, as well as ways your practice can identify which areas to focus on during your audit.
• Chapter 3: Understanding the structure of an E/M audit
  Explores how to structure an audit, including identifying sample size, establishing a baseline, tracking audit results, and determining an audit cycle.
• Chapter 4: Auditing E/M levels using an audit tool
  Walks the reader through the audit process using an audit tool and a case-study scenario that highlights the differences between the 1995 and 1997 guidelines.
• Chapter 5: Packaging your audit
  Explains how to draft a provider audit summary, a practice audit summary, revenue reports, and an action plan.
• Chapter 6: Devising a compliance plan
  Shows practices how to implement a new provider orientation, target outlier physicians, hold physician education sessions, and draft an audit policy/procedure.

Earn valuable Continuing Eduation Credits

This publication has prior approval of the American Academy of Professional Coders for 8.0 Continuing Education Units.  Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.

All the tools and resources you need

Auditing Evaluation and Management Coding contains everything you need to conduct an E/M audit at your practice, including:

• an E/M audit tool used by auditors across the country
• 15 real case studies for each level of E/M office visit service that demonstrate how to assign a code using the 1995 vs. 1997 documentation guidelines
• links to CMS audit tools used by carriers and other E/M audit forms used in the industry
• expert guidance on how documentation can affect code assignment, compliance, and reimbursement
• step-by-step instructions on how to structure your audit and report your findings
• easy-to-follow example scenarios for each level of E/M office visit service

Auditing Evaluation and Management Coding will give you the confidence to perform an actual compliance audit and bill your practice appropriately. With this valuable book and CD-ROM, you can rest assured your billing practices are in compliance and your practice is getting all the revenue it deserves. Order your copy today!

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