BC Advantage - 2018 Issue 5

The Devil is in the Data Details

As an auditor who has reviewed thousands and thousands of encounter documents for level of service, a predictable pattern has merged when it comes to the Medical Decision Making (MDM) component that has attracted my attention. Let's delve into the formula for a moment. There are four levels of complexity under MDM: Straightforward, Low, Moderate and High. The level of complexity is defined by determining the level of elements of MDM: the number of diagnoses or management options, the level of risk and the amount and complexity of data. Selecting the level of complexity is based on the...

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