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Physician/Clinician and Outpatient Hospital reimbursement for evaluation and management services is based on the level of service provided. Audits by CMS and private payers often result in findings of both coding a higher level of E/M service and coding a lower level of E/M service than is supported by the documentation in the medical record. Up-coding can result in serious fines even when it isn’t done intentionally. Down-coding results in the physician or facility not getting the full amount of reimbursement to which they are legally and ethically entitled. Sometimes, payers identify “up-coding” that isn’t supported by the documentation even though the service was performed at the higher level. Effective auditing identifies opportunities to improve clinical documentation and to increase the accuracy of coding.
This webinar presents methods to improve the accuracy of evaluation and management (E/M) coding of E/M services by physicians and other qualified health professionals in all settings and of outpatient hospital E/M services for hospital reimbursement. An effective technique to audit the current coding of these services and identify opportunities to improve documentation and coding will be discussed.
Area Covered In The Session:
- Effective auditing of E/M codes
- Effective auditing of clinical documentation supporting E/M coding
- Improving clinical documentation to accurately and specifically reflect the degree of the history and physical exam and the complexity of medical decision making
- Efficiently and accurately coding E/M services
At the conclusion of this presentation, participants will be able to:
- Audit E/M coding
- Evaluate clinical documentation
- Improve clinical documentation to clearly support the actual level of E/M service provided
- Accurately code E/M services
- Outpatients Hospital Coders
- Physicians Coders
- Clinicians Coders
- Billing Specialitsts
- Coding Manager
- Practice Manager
About Our Speaker:
Brandy Ziesemer, RHIA, CCS, ICD-10-CM/PCS Trainer is the health information program manager and professor with Lake-Sumter State College. She is a Registered Health Information Administrator and a Certified Coder Specialist. She was an AHIMA-approved ICD-10-CM & PCS Trainer from August 2011 through June 2017. She is also a member of: the American Health Information Management Association and the Florida Health Information Management Association (AHIMA/FHIMA), the Health Information Management Systems Society (HIMSS) and of the Professional Association of Healthcare Office Managers (PAHCOM).
Brandy was the FHIMA ICD-10 Task Force Leader from July 2013-June 2015. The focus of the taskforce included ICD-10-CM/PCS training (basic and “All Hands on Deck), physician outreach and education in Florida, and acting as a liaison between CMS along with their training partner, Noblis, FHIMA, PAHCOM and AAPC to offer free training to clinicians and their staff.
Over the past year, Brandy has presented several “Food for Thought” sessions for practice managers affiliated with Florida Hospital Waterman. Topics included: MACRA/MIPS; Documentation Improvement to increase the accuracy and specificity of ICD-10-CM code selection; and mastering the correct use of CPT/HCPCS modifiers.
Brandy has co-authored a CPT coding book, contributed to a health informatics book and written a text on Medical Office Management and Technology. She is also the editor of PAHCOM’s six Practice Management Manuals and an advisor to PAHCOM’s education staff.
Brandy has been awarded 3 service awards through FHIMA: Educator of the Year; Literary Award and in 2015, Distinguished Services Award.
Prior to joining the LSSC faculty in 1997, she had extensive experience working with managed care organizations in California and New Jersey, and consulting in physician practice management in Florida. She and her husband moved to Florida from Northern California in 1993.