decisionhealth Newsletters, Part B News - 2012 Issue 10 (October)
15 states subject to RAC E/M audit; assess vulnerability to prevent recoupments
Subscribe or sign in to view the full article.
Article Overview
This article explains a CMS-approved recovery audit issue focused on evaluation and management coding and the resulting risk of retrospective review in a defined set of states. It is written for coding, compliance, and practice-management audiences who need to understand the scope of the audit, how documentation may be reviewed, and what general areas to examine when assessing whether claims are vulnerable to recoupment. The discussion also places the audit in the context of broader E/M scrutiny and includes high-level guidance on internal review and physician education.
Why This Topic Matters
Practices that bill a high volume of higher-level evaluation and management services may be affected by retrospective audit activity and possible payment recovery. Understanding the article helps organizations gauge whether their documentation, utilization patterns, and compliance processes warrant closer review.
Article Sections
-
Audit announcement and regional scope
Overview of the CMS-approved recovery audit issue, the affected region, and the general time frame of retrospective review.
-
4 steps to a proactive response
High-level suggestions for practices evaluating their own E/M utilization and internal compliance readiness.
-
What to look for in a documentation review
Broad areas to consider when sampling charts and reviewing higher-level E/M documentation for consistency and support.
What You Will Learn
- How the article frames the scope of the recovery audit affecting E/M billing
- What types of internal review activities practices may consider when assessing exposure
- Which broad documentation patterns the article suggests reviewing for compliance readiness
- How the article situates the audit within larger E/M oversight trends
Who Should Read This
- Medical coders
- Compliance officers
- Practice managers
- Physicians
- Billing staff
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com