Clustering Levels of Evaluation and Management Services: Avoid the Compliance Trap

Article Overview

This article discusses the compliance and audit implications of clustering in evaluation and management services. It places the topic in the context of CMS, OIG, and physician practice compliance efforts, and covers broad areas such as documentation standards, billing integrity, self-auditing, corrective action, and distinguishing erroneous claims from fraudulent claims. It is intended for physicians, coders, compliance staff, and practice managers who want to understand why clustering is a risk area and what general compliance themes surround it.