ED Coding & Reimbursement Alert - 2012 Issue 23
Compliance: Consider These 3 Self-Audit FAQs As You Review Your Practice's Claims
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Article Overview
This article explains how Part B practices can use self-audits to review evaluation and management claim documentation, with emphasis on time-based reporting, required history elements for new patient visits, and the role of medical necessity in selecting visit levels. It is written for physicians, coders, billers, auditors, and compliance staff who review office visit claims and want to understand common documentation gaps that can affect claim support. The discussion stays at a general compliance level while covering the kinds of documentation and review issues that arise in everyday practice audits.
Why This Topic Matters
Self-audits can help practices identify documentation weaknesses before an outside auditor does, supporting more accurate claims review and better compliance oversight. This topic is especially relevant for teams that manage office visit coding, physician documentation, and internal audit workflows.
Article Sections
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Background
Introduces the purpose of self-audits for practice claims review and frames the documentation and compliance concerns discussed in the article.
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Get Into the Habit of Documenting Time Spent
Addresses documentation of time in evaluation and management encounters and the broader audit concerns raised when time-based support is missing or incomplete.
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You Must Meet Minimum History Requirement to Bill New Patient
Discusses documentation review for new patient office visits and the need to confirm that the record supports the required encounter components.
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Doctor Overdocuments History, Exam? You Can't Always Bill 99215
Reviews how audit findings can raise questions when documentation appears extensive but the overall encounter support must still align with the level of service selected.
What You Will Learn
- How self-audits can reveal documentation and compliance issues in practice claims
- What types of evaluation and management documentation are commonly reviewed during audit
- Why time documentation matters in certain office visit encounters
- Why new patient visit support must be reviewed carefully during claims audits
- How medical necessity factors into evaluation and management level selection
Who Should Read This
- Physicians
- Medical coders
- Billers
- Practice auditors
- Compliance staff
- Revenue cycle teams
Codes Discussed
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