tci Medicare Compliance & Reimbursement - 2013 Issue 1

Compliance: ED Coders: Expect Close Scrutiny on E/M Claims

EHRs being made the culprit of E/M code abuse. The sharp rise in upcoding of evaluation and management encounters in emergency departments is being attributed to the increase in EHR use by the media and the HHS Office of the Inspector General. In May 2012, the HHS OIG issued a report citing that ED E/M’s were the fifth largest paying codes in Medicare among all of the E/M codes, says Ed Gaines, JD, CCP Chief Compliance Officer for Medical Management Professionals, Inc, in Greensboro, NC. While acknowledging that it had not performed chart or medical record reviews of...

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