HCPro, JustCoding Outpatient - 2021 Issue 8 (February)
E/M risk assessments: A strategy for achieving coding compliance
February 23rd, 2021
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Article Overview
This article covers a practical framework for E/M-related risk assessments used by coding managers and compliance-focused practices. It discusses broad compliance risk areas, general sources of billing concern, and a five-step process for organizing, assessing, ranking, and managing risks. The piece is aimed at physicians, coding staff, practice managers, and compliance teams who want to better understand how risk assessments support coding and billing oversight.
Why This Topic Matters
Risk assessments can help practices identify compliance vulnerabilities before they become audit, repayment, or operational problems. The article is relevant to organizations trying to strengthen internal controls around E/M coding and billing.
Article Sections
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High-risk areas to monitor
Introduces broad categories of billing and compliance risk that practices may review during a risk assessment. It also references external oversight sources and general data patterns used to spot potential concerns.
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Five steps to include
Outlines the overall workflow for completing a risk assessment and introduces the major stages used in the process.
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Plan
Covers the first stage of the assessment process and focuses on setting goals and preparing the review at a high level.
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Organize
Describes ways to structure assessment tools, gather responses, and apply a general framework for comparing areas of risk.
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Develop a weighting system
Discusses approaches for scoring or weighting assessment responses and combining results for review.
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Assess
Explains who may participate in completing the assessment and how broader staff involvement can affect the results.
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Rank
Covers the process of ordering identified risks and using that information to determine where follow-up attention should be directed.
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Manage
Addresses the creation of an action plan to track identified risks, responsibilities, and follow-up timing.
What You Will Learn
- The general purpose of E/M risk assessments in a compliance program
- Common categories of billing and coding risk reviewed in assessments
- How a practice can structure a basic risk assessment workflow
- How results may be organized, weighted, ranked, and acted upon
- How assessment findings can inform audits, education, and internal controls
Who Should Read This
- Coding managers
- Physician practices
- Practice managers
- Compliance officers
- Coding and billing staff
- Auditing professionals
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