Between a rock and a hard place with E/M coding: dilemmas of compliance and practice financial viability.
Compliance with HCFA's Evaluation and Management (E/M) documentation guidelines presents a tremendous challenge to physicians and their staffs due to the complexity of the guidelines. All too frequently, physicians and staff undercode the services actually provided to prevent additional scrutiny and fraud and abuse charges. This results in significant lost revenue for the practice. This article provides guidance on how to ensure accurate reimbursement while complying with E/M guidelines. Special direction is provided on when and how to bill for a consultation.
Sosa
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Weill Medical College, Cornell University, New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
Cascardo
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D014487:Centers for Medicare and Medicaid Services, U.S.; D004282:Documentation; D005568:Forms and Records Control; D006801:Humans; D007344:Insurance Claim Reporting / Q000592:standards*; D007349:Insurance, Health, Reimbursement; D011216:Practice Management, Medical / Q000191:economics / Q000458:organization & administration*; D012308:Risk Management; D014481:United States