Payer Pointers: Get the Scoop on E/M Myths Direct From NGS

Why This Topic Matters

Medicare contractor updates can affect everyday coding, billing, and documentation workflows, especially when practices are trying to avoid denials, support E/M services correctly, and coordinate claims across payers. This article helps readers understand which policy areas NGS addressed and whether the discussion is pertinent to their own workflows.

Article Sections

1. Risk Factors Include Array of Options

   Discussion of the risk-related questions raised during the teleconference and the broad categories of factors the contractor addressed in relation to medical decision-making.

2. Where Is National X{EPSU} Guidance?

   Overview of the questions surrounding newer modifier guidance, CMS clarification, and the relationship between the newer modifiers and established modifier policies.

3. Keep Working toward ICD-10

   Coverage of the teleconference remarks on ICD-10 timing and the availability of testing opportunities through Medicare contractors.

4. Can ‘Pain Level’ Be Used Twice?

   A documentation-related question about review of systems and exam information in the context of E/M recordkeeping.

5. Medicare Requires E/M Face-to-Face

   Discussion of a Medicare billing question involving E/M services, counseling, and the presence of the patient during the encounter.

6. Medicare Won’t Pay Statutorily Excluded Services

   A dual-coverage billing discussion involving Medicare, Medicaid, statutory exclusions, and beneficiary billing concerns.

7. Nail Down Billing Provider or Risk PQRS

   Conversation about billing provider identification for therapy services and the potential effect on quality reporting.