Ignoring E/M red flags is like inviting OIG to audit your claims

Why This Topic Matters

The article helps readers recognize why E/M billing patterns may attract Medicare and payer review and why documentation practices can affect audit exposure and revenue. It is relevant for practices trying to understand the compliance and operational impact of coding trend analysis.

Article Sections

1. Medicare E/M coding trends and OIG findings

   Introduces the OIG report and the broader Medicare E/M billing patterns it examined. Discusses how the findings relate to physician audit exposure and payer scrutiny.

2. Documentation, downcoding, and revenue risk

   Focuses on how documentation quality and chart habits can affect service level selection. Covers general concerns about under-documentation, carry-forward content, and revenue loss.

3. Office, inpatient, and emergency department billing patterns

   Reviews trend changes across major E/M service categories. Addresses how billing patterns differ across office visits, inpatient care, and emergency department services.

4. Audit risk, geography, and contractor review

   Discusses audit exposure across different locations and practice settings. Includes general commentary on carrier probes, contractor review, and the likelihood of audit activity.

5. Education, recommendations, and choosing an auditor

   Summarizes the article’s discussion of education efforts, contractor review, and the use of outside auditing support. Notes the distinction between chart auditing and coding review.