Auditing Evaluation and Management Coding: A Step-by-Step Guide to Enhancing your Practice's revenue and Compliance / Edition 1

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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. Written by Joe Rivet, CPC, CCS-P 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.
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Editorial Reviews

Doody's Review Service
Reviewer: LouAnn Schraffenberger, MBA, RHIA, CCS, CCS-P(Advocate Health Care)
Description: This is a guide on how to conduct an audit of CPT evaluation and management (E&M) code usage. E&M codes are used by physicians and other healthcare providers to describe and bill to health insurance companies the healthcare services they provide to their patients such as office visits, hospital visits, consultations, and other non-procedural services.
Purpose: The purpose is to provide readers with a step-by-step guide to conduct an E&M code audit. The book describes how to select an E&M code, how to conduct the entire audit and how to report the audit findings. The goal is to assure acute data capture and maximum reimbursement for the healthcare provider.
Audience: Individuals who would be interested in the subject are physician coders, office managers, compliance officers, physicians, and others involved in the business management of a physician office or medical group practice. The two authors are certified coders with experience in physician practice coding management and compliance audits.
Features: Chapter 1 provides the reader with a step-by-step approach to choosing an E&M code. Chapter 2 outlines how to perform a risk assessment to take inventory of risk areas and identify risks in terms of code selection. Chapter 3 describes how to structure an audit, including the sample size, establishing a baseline, tracking results, and determining the audit cycle. Chapter 4 details the audit process using an audit tool and a case-study scenario. Chapter 5 explains how to draft an audit summary, revenue reports, and an action plan. Chapter 6 identifies how to implement a coding compliance plan. Accompanying the book is a CD-ROM that contains several audit forms, references for auditing, supplemental information, and case study exercises.
Assessment: This is a straightforward, step-by-step guide to assist physician coders or practice managers develop an ongoing E&M coding audit program. The chapters focus on specific steps in the process and provide good advice and suggestions. The CD-ROM contains supplemental chapters with exercises, a variety of guidelines published by reputable sources, and custom forms. By reading the book and completing an evaluation, readers can receive continuing education credit for maintenance of the American Academy of Professional Coders (AAPC) credentials. I find the price a little high for a 110-page book and CD-ROM as it is not a one-of-a-kind reference on the market. The book is quick and easy to read and offers the reader solid, practical advice on conducting important work on behalf of physicians for their accurate reporting of E&M codes for their professional reimbursement.
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Product Details

  • ISBN-13: 9781578398157
  • Publisher: HcPro
  • Publication date: 5/1/2007
  • Edition number: 1
  • Pages: 110
  • Product dimensions: 8.30 (w) x 10.90 (h) x 0.40 (d)

Table of Contents

About the authors     vii
Introduction     xi
Importance of auditing E/M codes     xi
Common auditing errors: What you may see when auditing your practice     xii
E/M-related resources     xii
E/M guidelines: 1995 vs. 1997     xiv
From an auditor's view: Documentation essentials     xiv
Administrative buy-in     xv
How this book will help you     xvi
How this book is organized     xvi
How to use the CD-ROM     xvii
What's included on your CD-ROM     xviii
Acronyms used in this book     xix
Continuing education instructional guide     xxi
Choosing an E/M code     1
E/M code components     2
Consultations     18
Test your knowledge     21
Performing a risk assessment     23
High-risk areas to monitor     24
Five steps to include     26
Risk data categories     29
Items that can affect risk     30
Test your knowledge     32
E/M audit structure     33
Getting started     33
Choosing an auditor     34
Preaudit preparations     35
Deciding when to audit     38
Establishing a baseline     39
Tracking audit results     42
Auditing teaching physicians     43
Establishing an audit cycle     43
Scoring providers using a matrix     44
Other audit considerations     47
Test your knowledge     49
Using an audit tool     51
Sample medical record documentation     51
History     52
Exam     56
Medical decision-making     60
Final audit results     66
Test your knowledge     67
Packaging your audit     69
Audit reports to include     70
Additional documents to consider     72
Test your knowledge     73
Devising a compliance plan     75
Plan overview     75
Audit policy/procedure     76
New provider orientation     76
Outlier providers     78
Ongoing education     79
Test your knowledge     84
Answers     85
Sample medical record examples     93
New patient office visits (codes 99201-99205)     95
Established patient office visits (codes 99211-99215)     101
Consultation office visits (codes 99241-99245)     105
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  • Anonymous

    Posted July 30, 2009


    Excellent resource. A must have.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted July 30, 2009

    This book is perfect for people new to E/M auditing or coding or those wanting to enhance their current procedures and processes. I highly recommend this text to professionals in the field.

    This book is perfect for any coding compliance department or physician practice. It has all the tools and guidance at your finger tips. The authors are nationally known in the industry and really make this difficult topic very clear.

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