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E/M Auditing Fundamentals

Duration : 60 Minutes


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 impact each step of the revenue cycle in healthcare practices. Pam Read more

This session will expand your knowledge of evaluation and management coding and auditing. Greater scrutiny from the OIG, government-contracted and third-party auditors make practice self-checks of physician E/M coding is 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. The risks of being non-compliant with documentation and coding are too great.

Course Objectives:

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

Why Should You Attend:

The fiscal year (FY) 2017 Medicare FFS program improper payment rate is 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.”

Course Outline:

• Did you know if you are billing for a Federal program, Medicare/Medicaid, the organization should have a compliance plan?
• Do you have an effective compliance plan in place that includes auditing and monitoring?
• Are you conducting random audits on E/M coding documentation before submitting to carrier?
• Is your team proficient in determining medical necessity verses medical decision-making?
• What percentage of undercoding / upcoding does your providers have?
• Are you confident that your coding practices are compliant with the regulations set forth by private and government payors?
• Is there regular communication between your providers and staff on how to use documentation to maintain compliance and proper reimbursement?

What You Get:

• Training Materials
• Live Q&A Session with our Expert
• Participation Certificate
• Access to Signup Community (Optional)
• Reward Points

Who Will Benefit:

• Medical billing and coding teams
• Auditors
• Medical Practice Managers/Administrators,
• Physicians
• Clinical and practice staff involved in coding
• Compliance Officers/Committees
• Revenue Cycle Management Professionals

Please reach us at 1-888-844-8963 for any further assistance or if you wish to register

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Subject : E/M Auditing Fundamentals

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