ED Coding & Reimbursement Alert - 2013 Issue 39
Compliance: RACs Identify 2 Error-Prone E/M Issues
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Article Overview
This article summarizes recent CMS Medicare compliance guidance focused on two common evaluation and management billing problem areas identified by recovery audit contractors. It is aimed at coders, billers, and clinical documentation staff who need a high-level understanding of inpatient-versus-outpatient E/M reporting concerns and how E/M services may relate to allergy testing or immunotherapy. The article discusses the general compliance issues, the role of documentation, and the types of billing situations that may trigger payer review.
Why This Topic Matters
These issues can lead to incorrect E/M reporting and compliance risk if the place of service or service bundling is misunderstood. The article helps readers recognize when documentation and claim review are especially important.
Article Sections
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Check Your Inpatient Office Visits
Discusses RAC findings related to E/M services provided to hospital inpatients and the risk of reporting outpatient hospital E/M services in the wrong setting. It also highlights documentation clues that may help identify when an encounter occurred in the hospital.
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Use Caution for E/M With Allergy Visit
Covers compliance concerns involving E/M visits that occur with allergy testing or immunotherapy. The section addresses documentation, separately identifiable services, and the general billing context for allergy-related encounters.
What You Will Learn
- How recent Medicare compliance findings relate to inpatient and allergy-related E/M billing.
- What kinds of documentation issues may raise concern when setting and service type do not appear to match.
- Why separately identifiable services matter when E/M is performed alongside allergy-related procedures.
- Which general compliance topics CMS highlights in its quarterly provider newsletter.
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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