decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 5 (May)
Understanding E/M: Keep up audits, look out for EHR prompts to high-level E/Ms after OIG report
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Article Overview
This article reviews a government report on evaluation and management billing trends and explains why the findings matter to physician practices, auditors, and compliance staff. It summarizes the report’s focus on higher-level E/M utilization, the response from CMS and Medicare contractors, and practical concerns raised by experts about physician education, documentation quality, EHR workflows, and audit oversight. The piece is aimed at readers who need to understand the compliance implications without mistaking utilization trends for proof of improper billing.
Why This Topic Matters
It helps practices interpret a high-level E/M billing trend report in context and highlights the operational areas most likely to draw audit attention, especially documentation and EHR-related coding behavior.
Article Sections
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Report overview and billing trend findings
Summarizes the federal report’s scope and the broad E/M utilization trend it describes over time. It also introduces the agency’s concerns and the physician population identified for review.
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Why experts say not to overreact
Presents comments from specialty and billing leaders on how to interpret the report cautiously. This section discusses the lack of specific fraud findings and the response from professional organizations and CMS.
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EHR adoption, acuity, and documentation patterns
Explores possible reasons experts believe higher-level E/M billing may be increasing. It addresses changes in documentation habits and the influence of electronic health record use.
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2 tips to justify E/M selection
Provides general audit and documentation themes raised by the article for supporting E/M level selection. It also discusses EHR workflow risks and the importance of physician training.
What You Will Learn
- How a federal report framed trends in E/M billing over time
- Why the report prompted compliance concern without establishing improper billing
- What audit and education practices experts recommend for physician groups
- How EHR documentation features can affect coding oversight
- What broad operational issues may attract MAC review attention
Who Should Read This
- Physician practices
- Medical coders
- Compliance staff
- Billing managers
- Auditors
- Practice administrators
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