Medicare Compliance & Reimbursement - 2012 Issue 8
E/M Reimbursement: Don't Forfeit Pay by Choosing 'Safer' Office Visit Code
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Article Overview
This article explains why conservative evaluation and management (E/M) coding can create compliance exposure and revenue loss for physician practices, especially in office visit billing. It is aimed at surgeons, coders, billers, and compliance-focused staff who want to understand audit risk, False Claims Act concerns, and the financial effect of undercoding. The discussion centers on general E/M documentation and coding accuracy, along with examples tied to office visit levels.
Why This Topic Matters
Coding too conservatively can affect reimbursement, invite scrutiny from auditors, and create compliance risk if inaccurate claims are submitted knowingly. Understanding the broader impact helps practices improve documentation and select E/M levels more accurately.
What You Will Learn
- Why conservative E/M coding may still attract audit attention
- How undercoding can raise compliance concerns under federal law
- How inaccurate code selection can affect annual practice revenue
- Why documentation quality matters for accurate office visit E/M reporting
Who Should Read This
- Surgeons
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
Codes Discussed
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