Use Self-Audits to Uncover, Correct Coding Issues

By Lewis, Maxine | Medical Economics, December 25, 2012 | Go to article overview

Use Self-Audits to Uncover, Correct Coding Issues


Lewis, Maxine, Medical Economics


Q: I recently received a letter from one of my third-party payers regarding its use of level 4 and level S evaluation and management (E/M) codes compared with other doctors in my specialty. What do I do now?

A: This type of analysis is happening more frequently with many payers. It's called data mining, and payers are using the level of service claims you submit and comparing them with those submitted by doctors in your area with the same specialty. Sometimes payers make a list of patients you billed for a level 4 or level 5 office visit, or the number of times you billed at such levels during a specific period.

Education is an important part of auditing. If you do not comply with the federal government's guidelines, you must learn to provide the medically necessary information for the level of service billed. Otherwise, you must report at a lower level.

Conduct a self-audit to uncover and correct any issues. Here's how.

1. Print the codes from your practice management system for the levels in question. Compare them with those sent by the payer. If the numbers do not match, and if no list of beneficiaries exists from which the data were abstracted, then request the patient list Check the names on this list to be certain the patients are yours and assigned to a doctor in your practice.

2. Review your charts. Is the coding and billing in compliance with the payer's requirements? Are the services performed medically reasonable and necessary? Is the necessary documentation for the specific level of E/M services included?

3. Correct the mistakes you find in your charts. Let's look at some common issues and how you can fix them.

* Insufficient information. An E/M service consists of history, examination, and medical decision-making. A common omission in the history portion is a clearly stated chief complaint Although it frequently can be found in the history of present illness, many times recheck or follow-up is listed as the chief complaint You need more documentation than that for an appropriate chief complaint however. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Use Self-Audits to Uncover, Correct Coding Issues
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.