tci Medicare Compliance & Reimbursement - 2014 Issue 13
E/M Coding: E/M Services Aren't Automatically Billable Every Time You See a Patient
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Article Overview
This article summarizes OIG findings on improper payment issues tied to evaluation and management services and explains why E/M claims draw increased audit attention. It is relevant to physicians, coders, billers, compliance staff, and practice managers who need to understand the main categories of documentation and billing problems discussed in the report.
Why This Topic Matters
E/M claims are a major source of payment risk because documentation quality, code selection, and claim completeness can affect audit exposure and reimbursement accuracy. The article helps readers understand the general compliance concerns highlighted by the OIG and why these claims are being closely reviewed.
What You Will Learn
- The main types of E/M claim problems identified in the OIG report
- Why documentation quality matters for E/M billing accuracy
- How audit findings can affect physician practices and facilities
- The broader compliance issues associated with E/M claim review
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Revenue cycle professionals
Codes Discussed
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