Medicare Compliance & Reimbursement - 2006 Issue 6
EVALUATION & MANAGEMENT: Don't Hold Your Breath For New National E/M Guidelines
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Article Overview
This article discusses the status of evaluation and management documentation guidance at the national level and the possibility that Medicare carriers may continue developing regional approaches. It is relevant to coders, billers, compliance staff, and physician practices that track E/M policy changes, audit trends, and documentation expectations. The piece focuses on the broader policy environment, the roles of the AMA and CMS, and the implications of regional variation for claims review and comparison across markets.
Why This Topic Matters
Changes or differences in E/M guidance can affect documentation practices, audit risk, and the consistency of claims review across regions. Readers who work with physician billing or compliance need to understand how national policy uncertainty may interact with carrier-level guidance.
What You Will Learn
- The current status of national E/M documentation guidance
- How carrier-level regional guidance may affect audits and claims review
- Why differing regional rules matter for physician documentation comparisons
- The relationship among the AMA, CMS, and Medicare carriers on E/M policy
- Potential timing and adoption issues for new local guidance
Who Should Read This
- Medical coders
- Professional fee billers
- Revenue cycle staff
- Compliance officers
- Physician practice managers
- Healthcare consultants
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