Avoiding audits by benchmarking your E/M coding.
Providers are well aware that appropriate coding is the key to prompt payment of claims submitted for services. Payers do reserve the right to review payments at a later date, however. The auditing process is costly, time consuming, and often traumatic for practices. This article provides an overview of the coding and payment process. The author suggests that practices audit their own clinical records on a periodic basis and compare the distribution of their codes with national and/or specialty benchmarks. In addition, practices must weigh whether the coding level is supported by appropriate documentation.
Stavrakas-Souba
Lisa
L
LAS Practice Management and Coding Services, LLC, P.O. Box 4624, Breckenridge, CO 80424, USA.
D019985:Benchmarking; D014487:Centers for Medicare and Medicaid Services, U.S.; D003954:Diagnostic Services / Q000191:economics*; D018588:Fee-for-Service Plans; D005568:Forms and Records Control / Q000145:classification; D006801:Humans; D007344:Insurance Claim Reporting / Q000145:classification*; D016345:Medicare Part B / Q000592:standards*; D011216:Practice Management, Medical / Q000191:economics*; D014481:United States