E/M risk assessments: Build a strategy for achieving coding compliance

Why This Topic Matters

A well-designed risk assessment can help practices identify documentation, billing, and workflow vulnerabilities before they lead to payer audits, repayment exposure, or other compliance problems. The article is relevant for organizations trying to strengthen internal controls and maintain coding compliance during documentation changes.

Article Sections

1. High-risk areas to monitor

   Introduces common compliance risk areas in physician coding and billing and discusses why claims activity and documentation patterns merit review. It also mentions oversight resources used to identify focus areas for audit readiness.

2. First, five steps

   Outlines the overall framework for conducting a risk assessment by dividing the process into five major phases. The section serves as the roadmap for the remainder of the article.

3. Plan

   Describes the planning phase of a risk assessment, including defining goals, setting objectives, and preparing for an initial baseline review.

4. Organize

   Covers how to structure the assessment, define areas of focus, and collect information from staff using tools such as questionnaires and scoring approaches.

5. Develop a weighting system

   Explains how assessment responses may be scored and compared so practices can evaluate relative levels of concern and identify areas needing attention.

6. Assess

   Discusses distributing the assessment tool to the appropriate participants within a practice so the organization can gather broad input.

7. Rank

   Addresses how results can be ordered by priority after data collection and how practices may use the ranking to decide what to focus on first.

8. Manage

   Describes the final step of turning assessment findings into an action plan with responsibilities and follow-up expectations.