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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
2012: OIG declares war on E/Ms
2012: OIG declares war on E/Ms
2012: OIG declares war on E/Ms
2012: OIG declares war on E/Ms
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
www.decisionhealth.com
Download the OIG’s hit list of 1,700 NPI numbers
http://decisionhealth.com/pdf/OIG_FOIA_list.pdf
www.decisionhealth.com
For questions, price quotes, custom demos, contact:
Erica Evans Product Consultant
1-301-287-2394
Gary Belski Product Consultant
1-301-287-2285