E/M Auditing Essentials: Improve Documentation and Decrease Improper Payments
Pam Joslin, MM, CMC, CMIS, CMOM, CMCO, CEMA, CMCA-E/M
Pam has more than 20 years of medical practice management, billing and coding, reimbursement, auditing, and compliance experience. She is an engaging presenter via webinar, classroom, and conference on various topics that may impact each step in the life of the revenue cycle of every practice.
She has managed in medical practices ranging from single to multi-specialty groups, including ASC. She is an advocate of process improvement and maximizing and empowering employees to bring about the "best practice” results for your organization.
She received her Masters in Management from the University of Phoenix. Pam maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry.
This session will expand your knowledge of evaluation and management coding audits and discover areas of insufficient documentation that may decrease the revenues received into your organization. Greater scrutiny from the OIG, government-contracted and third-party auditors make practice self-checks of physician E/M coding more important than ever. CMS sees physician education and outreach as critical parts of an effective enforcement strategy and clarify policies when inconsistencies in billing practices arise. Attend this program to enhance your understanding of level-of-service audits. Improving audit proficiency will reduce risk and promote accurate claim submissions in your healthcare organization that may decrease improper payments.
The fiscal year (FY) 2017 Medicare FFS program improper payment rate was 9.51 percent, representing $36.21 billion in improper payments. “Best practices” in healthcare have an effective compliance plan in place that contains all seven elements. One of those elements is “auditing”.
This is an opportunity to look at your current process as well as obtain useful information on how to get started with an auditing program in your organization. Proactive review with auditing your claims prior to submission will increase revenues, decrease denials, rejects, and assist your organization in being compliant, so when you receive revenue – your will “get to keep it” because you are lower the chances of improper payment activities by implementing “best practice auditing essentials.” the risks of being non-compliant with documentation and coding are too great.
- The benefits of establishing an effective chart audit process
- Step-by-step review of documentation requirements for ’95 vs. ’97 guidelines
- Guidance on selecting the level of medical decision-making
- Hands-on demonstration for aligning documentation to key components for “telling an accurate patient story”
As a result of this training, attendees will:
- Understand how to implement and monitor an effective E/M audit plan
- Know how to tell an accurate patient story by aligning documentation to key components in the medical record
- Enhance skills in understanding the difference between Medical Decision-Making and Medical Necessity of the visit
- Identify areas of risk leading to E/M over or under coding and documentation
- Ensure that your coding practices are compliant with the regulations set forth by private and government payors
- Teach your providers and staff how to use documentation to maintain compliance and proper reimbursement
Who Should Attend
- Clinical staff
- Compliance officers
Why Should Attend
- Gain useful information and tools for understanding the E/M auditing process
- Increase your understanding of documentation requirements for the three key components - history, exam, and medical decision-making.
- Take a proactive stance and learn to implement your own self-audit procedures. Conducting your own E/M coding audits is considered “best practices.”