tci Medicare Compliance & Reimbursement - 2007 Issue 38
The 3 Deadly Myths That Could Be Hindering Your E/M Chart Audits
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Article Overview
This article reviews common myths that can interfere with auditing evaluation and management services. It focuses on how audit criteria may differ across payers, the role of the 1995 and 1997 evaluation and management guidelines, and documentation considerations for history and review of systems. It is relevant to coders, auditors, compliance staff, and physician educators working with E/M chart reviews.
Why This Topic Matters
Understanding the range of audit approaches for evaluation and management services helps organizations avoid relying on oversimplified assumptions and supports more consistent chart review practices.
What You Will Learn
- How audit criteria for evaluation and management visits may vary by payer
- How the 1995 and 1997 E/M guideline sets are discussed in auditing contexts
- How documentation issues related to history and review of systems are addressed in chart audits
- Which common assumptions can affect the accuracy of E/M audit workflows
Who Should Read This
- Medical coders
- Chart auditors
- Compliance professionals
- Physician educators
- Revenue cycle staff
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