E/M Auditing & Medical Necessity

$215
$321
$199
$399
$315
$319
$198
$221
$211
$201

Description

This session will expand your knowledge of evaluation and management coding audits. 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. The risks of being non-compliant with documentation and coding are too great.

Why Should You 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.”

Areas Covered In The Session:

  • 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”

Learning Objectives:

  • 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

Target Audience:

  • Coders
  • Auditors
  • Providers
  • Clinical and Practice Staff involved in medical coding.
  • Consultants
  • Compliance Officers
  • Office Managers

Instructor Profile:

Pam Joslin, MM, CMC, CMIS, CMOM, CMCO, CEMA has more than 20 years of medical practice management, coding, reimbursement and compliance experience. She has managed medical practices ranging from single to multi-specialty groups, including an ASC. She is an advocate of process improvement and empowering employees to bring about the “best practice” results for their organization. Ms. Joslin maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry. In 2014 she joined the faculty of Practice Management Institute (PMI) ® – a leading provider of continuing education for medical office professionals. Prior to joining the PMI Instructor team, Pam was an Adjunct Instructor and served on three advisory boards at a community college in San Antonio, Texas.