Upcoding

Why This Topic Matters

The topic is relevant because it addresses coding compliance risk, payer review trends, and the operational impact of audit activity on cardiology practices.

Article Sections

1. HCFA scrutiny of cardiology evaluation and management claims

   Introduces the general issue of documentation review in cardiology visits and describes why certain evaluation and management claims are receiving additional attention.

2. Utilization and audit focus

   Summarizes utilization data and describes the carrier review focus described in the article, along with related federal audit context.

3. Documentation and compliance perspectives

   Presents comments from compliance and business-services personnel on common documentation challenges seen in cardiology chart reviews.

4. Tips to survive E/M upcoding onslaught

   Outlines broad compliance and workflow themes related to preparing for review, educating staff, and responding to audit requests.

5. Common charting gaps and audit follow-up

   Discusses recurring history and exam documentation issues, along with practice responses to audit findings and payer feedback.

6. Impact on Medicare and private payer audits

   Reviews the article’s broader discussion of coding error costs, improper payments, and the growing audit environment.