decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Auditing / Getting started
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Article Overview
This article introduces the basics of auditing evaluation and management (E/M) claims and charts for coding compliance. It outlines practical considerations for setting up an audit process, choosing the audit scope and format, organizing documentation, scheduling reviews, and incorporating provider education. It also touches on broader compliance topics that may be reviewed during audits, including modifiers, teaching rules, incident-to guidelines, local medical review policies, and advance beneficiary notices, along with Medicare documentation guideline versions.
Why This Topic Matters
For practices that bill E/M services, audits are a core compliance tool for identifying documentation and coding trends, supporting education, and helping reduce coding risk. This article is useful for anyone creating or refining an internal audit process.
Article Sections
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Audit planning and scope
Introduces the main choices involved in starting an audit program, including who conducts it, how many records are reviewed, and whether the review is prospective or retrospective. It also discusses how to organize the audit environment and supporting materials.
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Audit focus, scheduling, and education
Covers how to define review targets, establish a repeating audit schedule, and incorporate feedback for providers. It also addresses how audit results can support ongoing compliance education and monitoring.
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Expanding the audit review
Describes additional areas that may be added after an initial audit process is underway, including broader documentation and compliance review topics. It also notes a discussion of Medicare documentation guideline versions.
What You Will Learn
- How to approach the initial setup of an E/M audit program
- What factors affect audit scope and workflow
- Which broader compliance topics may be added to an audit review
- How audit activity can support provider education and monitoring
- What general documentation guideline options are discussed
Who Should Read This
- Medical coders
- Compliance staff
- Practice managers
- Billing supervisors
- Auditors
- Physician office administrators
Codes Discussed
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