tci Part B Insider - 2005 Issue 35

PHYSICIAN NOTES: Beware Audits Of Your E/M Claims On 'Points System'

Your carrier may follow the example of TrailBlazerIf TrailBlazer Health Enterprises is your carrier, you should go back and look at your evaluation and management claims right away to see if they meet the carrier's new guidelines.TrailBlazer's Medical Director Deborah Patterson announced Sept. 9 that the carrier has created new guidelines for auditing E/M claims, according to Quinten Buechner with ProActive Consultants in Cumberland, WI. The guidelines are different than the national standards, and other carriers may follow TrailBlazer's lead, Buechner warns. TrailBlazer has set up a complicated and confusing "points" system for medical decision-making (MDM). It gives...

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