Medicare Compliance & Reimbursement - 2016 Issue 3
Coding Compliance: Find Your E/M Coding Flaws with Self-Audits
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Article Overview
This article focuses on self-auditing evaluation and management (E/M) coding in medical practices. It discusses why E/M services are a common audit focus, how to review documentation against E/M guidelines, and how practices can structure internal or external audit workflows to identify documentation and coding mismatches. The piece is aimed at coders, billers, compliance staff, and practice managers who want to reduce risk, improve documentation support, and strengthen coding accuracy.
Why This Topic Matters
E/M coding errors can lead to denials, refunds, and compliance risk, so routine self-audits help practices identify documentation and coding problems early. The article is useful for organizations that want to improve internal controls and support more accurate billing processes.
Article Sections
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Why E/Ms Are Important to Self-audit
Explains why evaluation and management services are frequent audit targets and why practices prioritize them in compliance reviews.
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How to Self-audit E/M Services
Describes the general documentation review process for E/M claims, including common review approaches and audit tools referenced in the article.
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Who Should Conduct Self-audits
Covers staffing options for internal audits, including in-house reviewers and outside audit support, and discusses general workflow considerations.
What You Will Learn
- Why E/M coding is a common focus of compliance self-audits
- What broad documentation areas are reviewed during an E/M audit
- How practices can organize internal versus external audit responsibilities
- What kinds of audit patterns may signal a need for further review
- Which general tools and guideline sets are referenced for E/M review
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Physician office administrators
Codes Discussed
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